中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

不同种手术方式治疗胸腺瘤合并重症肌无力的比较

查看全文

目的 比较不同手术方式治疗胸腺瘤合并重症肌无力,探讨胸腔镜联合纵隔镜胸腺扩大切除术的临床疗效。 方法 回顾性分析 2011~2016 年江苏省苏北人民医院收治的胸腺瘤合并重症肌无力患者 58 例的临床资料。根据手术方式将患者分为 3 组:A 组(胸腔镜组)32 例,B 组(胸腔镜联合纵隔镜组)15 例,C 组(经胸骨正中开胸组)11 例。比较各组临床效果。 结果 在手术出血量、术后住院时间和总并发症发生率上,A 组和 B 组均显著小于或短于 C 组,差异有统计学意义(P<0.05);B 组肌无力危象发生率(6.7%) 低于 C 组(36.4%),但差异无统计学意义(PB-C=0.058);三组手术时间分别为 (122.0±39.4)min、(130.3±42.5)min、(142.3±40.8)min,组间差异无统计学意义 (P>0.05)。B 组清扫程度(1 级,12 例,80.0%)显著高于 A 组(1 级,14 例,43.8%,P<0.05)。三组术后有效率分别为 84.4%,93.3%,90.9%,组间差异无统计学意义 (P>0.05)。 结论 胸腔镜联合纵隔镜胸腺扩大切除术不仅具有创伤小、术后恢复快、并发症少等优势,而且能更为彻底地清扫胸腺及脂肪组织,能达到与胸骨正中开胸术式相当的治疗效果。

Objective To compare the different surgical treatment methods of thymoma combined with myasthenia gravis (MG), and to discuss the clinical effectiveness of thoracoscopic combined mediastinoscopic extended thymectomy. Methods We retrospectively analyzed the clinical data of 58 patients of thymoma combined with myasthenia gravis in Northern Jiangsu People's Hospital between 2011 and 2016 year. According to the operation method, the patients were divided into three groups including a group A for thoracoscopic thymectomy (n=32), a group B for thoracoscopic combined mediastinoscopic thymectomy (n=15), and a group C for transsternal thymectomy (n=11). The clinical effects were observed and compared. Results In the group A and the group B, the bleeding volume, postoperative hospital stay and other complications were significantly lower than those in the group C with statistical differences (P<0.05). The incidence of myasthenic crisis in the group B (6.7%) was less than that in the group C (36.4 %), but the difference was not statistically different (P=0.058). The operation time of the three groups was 122.0 ± 39.4 min, 130.3 ± 42.5 min, and 142.3 ± 40.8 min respectively with no statistical difference between the two groups (P>0.05). The rate of dissection grade in the group B (grade 1, 12 patients, 80%) was significantly greater than that in the group A (grade 1, 14 patients, 43.8%,P<0.05). The effective rate of the group A, the group B, the group C was 84.4%, 93.3% and 90.9%, respectively with no statistical difference between groups (P>0.05). Conclusion The thoracoscopy combined mediastinoscopic thymectomy not only has the advantages of less trauma, quicker recovery and fewer complications, but also can more thoroughly clean the thymus and adipose tissue, which can achieve the same therapeutic effect as the transsternal thymectomy.

关键词: 胸腺瘤; 重症肌无力; 胸腔镜联合纵隔镜; 胸腺切除术

Key words: Thymoma; myasthenia gravis; thoracoscopy combined with mediastinoscopy; thymectomy

引用本文: 唐桂旺, 叶敬霆, 武强, 唐善卫, 束余声. 不同种手术方式治疗胸腺瘤合并重症肌无力的比较. 中国胸心血管外科临床杂志, 2018, 25(9): 767-771. doi: 10.7507/1007-4848.201711029 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Marx A, Weis CA, Ströbel P. Thymomas. Pathologe, 2016, 37(5): 412-424.
2. Toker A, Sonett J, Zielinski M, et al. Standard terms, definitions, and policies for minimally invasive resection of thymoma. J Thorac Oncol, 2011, 6(7): S1739.
3. 束余声, 孙超, 陆世春. 电视纵隔镜下经颈小切口行胸腺切除治疗小儿重症肌无力. 中华小儿外科杂志, 2011, 32(7): 481-483.
4. Raza A, Woo E. Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg, 2016, 5(1): 33-37.
5. Agatsuma H, Yoshida K, Yoshino I, et al. Video-assisted rhoracic aurgery rhymectomy versus sternotomy thymectomy in patients with thymoma. Ann Thorac Surg, 2017, 104(3): 1047-1053.
6. 张文军, 范军, 马冬春, 等. 胸腔镜与胸骨正中劈开胸腺扩大切除治疗重症肌无力并胸腺瘤的比较. 安徽医科大学学报, 2016, 51(5): 755-758.
7. 齐瑞. 胸腔镜与开胸手术治疗重症肌无力合并胸腺瘤的随机对照研究. 中国医学工程, 2015, 9(23): 79-81.
8. Yang SB, Mao-Yong FU, Jie-Wei HU, et al. Analysis of the efficacy and safety of video assisted thoracic surgery and thoracic surgery in the treatment of myasthenia gravis. Prog Modern Biomed, 2017, 17(23): 4583-4585.
9. Yu L, Ma S, Jing Y, et al. Combined unilateral-thoracoscopic and mediastinoscopic thymectomy. Ann Thorac Surg, 2010, 90(6): 2068-2070.
10. Rd JA, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology, 2000, 55(1): 16-23.
11. Rd JA, penn AS, Younger DS, et al. "Maximal" thymectomy for myasthenia gravis. Results. Korean J Thorac Cardiovasc Surg, 1988, 95(5): 747.
12. 刘宇, 束余声. 胸腺切除术后发生肌无力危象危险因素的 Meta 分析. 中华胸心血管外科杂志, 2015, 31(11): 660-664.
13. Zielinski M, Kuzdzal J, Szlubowski A, et al. Comparison of late results of basic transsternal and extended transsternal thymectomies in the treatment of myasthenia gravis. Ann Thorac Surg, 2004, 78(1): 253.
14. 钱昆杰, 孙清超, 李德生, 等. 胸腺瘤合并重症肌无力患者术后远期疗效及影响因素分析. 中国胸心血管外科临床杂志, 2016, 23(7): 698-701.
15. Chao YK, Liu YH, Hsieh MJ, et al. Long-term outcomes after thoracoscopic resection of stage Ⅰ and Ⅱ thymoma: a propensity-matched study. Ann Surg Oncol, 2015, 22(4): 1371-1376.
16. 惠刚, 乌达, 陈保坤, 等. 胸腔镜扩大切除胸腺及胸腺瘤治疗重症肌无力. 广州医学院学报, 2013, 41(1): 41-43.
17. Gu ZT, Mao T, Chen WH, et al. Comparison of video-assisted thoracoscopic surgery and median sternotomy approaches for thymic tumor resections at a single institution. Surg Laparosc Endosc Percutan Tech, 2015, 25(1): 47-51.
18. Caronia FP, Arrigo E, Trovato S, et al. Uniportal bilateral video-assisted sequential thoracoscopic extended thymectomy. J Vis Surg, 2017, 3(1): 69.
19. 于磊, 马山, 王天佑, 等. 胸腔镜联合纵隔镜胸腺扩大切除治疗重症肌无力. 中华外科杂志, 2010, 48(6): 474-475.
20. Lin Q, Zhang Y, Yang L. Single-center retrospective analysis of 162 cases with thymoma complicating myastheniagravis. J BUON, 2017, 22(3): 741-745.
21. 缪乾兵, 石维平, 束余声, 等. 重症肌无力的外科治疗和围术期处理. 中国医师杂志, 2010, 12(11): 1504-1505.