电视胸腔镜与经胸骨正中切口胸腺扩大切除治疗重症肌无力的疗效比较  

Comparison of the early efficacy of extended thymectomy for myasthenia gravis between video-assisted thoracoscopy and median sternotomy

作　　者：陈伦元 刘丹[2] 王允[3] 任守阳 

机构地区：[1]彭州市人民医院外二科,四川彭州611930 [2]四川省资中县人民医院外一科,四川资中641200 [3]四川大学华西医院胸心血管外科,四川成都610041 [4]都江堰市水电十局医院外二科,四川都江堰611830

出　　处：《临床和实验医学杂志》2008年第6期1-3,共3页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金(30100181);四川大学青年科技基金(2003035)

摘　　要：目的比较电视胸腔镜(VATS)与胸骨正中切口胸腺扩大切除治疗重症肌无力的疗效。方法分析彭州市人民医院外二科2000年5月至2007年6月行胸腺扩大切除术治疗重症肌无力患者133例,根据手术方式的不同分为VATS组(53例)和开胸组(80例),通过分析手术时间、术中出血量、术后引流量、术后肌无力危象发生率等临床指标,比较其早期疗效。结果VATS组手术后引流量较开胸组增加,手术中出血量较开胸组减少;VATS组术后肌无力危象发生率为3.77%(2/53),开胸组术后肌无力危象发生率为13.75%(11/80),两组之间有统计学差异(P=0.042)。结论电视胸腔镜胸腺扩大切除术治疗重症肌无力具有良好的安全性,术中出血少,手术创伤小,能够减少术后肌无力危象发生,具有良好的临床应用前景。Objective Cost- effetiveness analysis was made and compared between esophagogastric mechanical anastomosis and esophagogastric demixing anastomosis with the use of three leaf clamp. Methods 133 patients who received extended thymectomy for MG during May 2000 to July 2007 in our department were divided into two groups by operative approach, which 53 patients in VATS group and 80 patients in sternotomy group. The clinical features, such as operative time, operative blood loss, postoperative drainage quantity, the incidence of crisis, duration of crisis （ time of mechanical ventilation）, were analysed to evaluate the early efficacy. Results The postoperative drainage quantity in VATS group was more than that in sternotomy group, and the operative blood loss in VATS group was less than that in sternotomy group. The incidence of crisis in VATS group was 3.77 % （ 2/53 ）, which was less than that in sternotymy group 13.75 % （ 11/80 ） （ P = 0. 042 ）. Concluslon Video - assisted thoracoscopic extended thymectomy for myasthenia gravis is safe and minimally invasive, can decrease the incidence of crisis and the time of mechanical ventilation of crisis, as well as operative blood loss.

关 键 词：电视胸腔镜手术 胸腺扩大切除 重症肌无力 

分 类 号：R655[医药卫生—外科学]