胸骨横断微创小切口胸腺扩大切除术治疗重症肌无力  

Enlarged thymectomy of transverse sternal microinvasive incision treating myasthemia gravis

作　　者：袁天柱[1] 张清勇[2] 杨鲲鹏[2] 黄壮士[2] 向敏峰[1] 廖文勇[1] 

机构地区：[1]广西医科大学第四附属医院胸心外科,柳州市545005 [2]郑州大学第二附属医院胸外科,郑州市450014

出　　处：《微创医学》2009年第2期99-101,共3页Journal of Minimally Invasive Medicine

基　　金：广西区卫生厅科研项目(E2008379);柳州市科技局项目(2008031413)

摘　　要：目的探讨经第二肋间胸骨横断微创伤小切口行胸腺扩大切除术治疗重症肌无力(myasthenia gravis,MG)的临床效果。方法对485例行第二肋间胸骨横断微创小切口胸腺完整切除治疗的MG患者的临床病理资料进行回顾分析。结果手术时间平均(70.4±18.6)min;术中出血平均(50.6±19.4)mL;术后多功能监护24～72 h;术后引流量平均(90.9±32.6)mL;无术后活动性出血需2次手术者,引流管均在术后48 h内拔出;未因疼痛而用镇痛药者;伤口Ⅰ/甲级愈合;术后发生危象21例,危象发生率为4.3%(21/485),其中18例治愈,2例自动出院,1例死亡。全组失访6例,其余病例随访6～82个月,无胸骨畸形愈合,完全缓解率46.8%(227/485)、部分缓解率40.9%(198/485),本组总有效率为87.6%(425/485)。结论充分术前准备后经第二肋间横断胸骨微创伤小切口行胸腺扩大切除术治疗重症肌无力创伤小、术后恢复快、美容、临床效果良好。Objective To explore the chnical effect of enlarged thymectomy of transverse sternal microinvasive incision at the 2nd intercostal space in treating myasthemia gravis （MG）. Methods A total number of 485 cases received total thymectomy of transverse sternal microinvasivc incision at the 2nd intereostals space together with anterior mediastinal adi- poelearance. All the patients＇ clinical and pathological data were reviewed. Results The average operating duration was （70.2±18.8） min with average bleeding of （50.6±19.4） ml. Postoperative mnltifunctional monitoring was time 24 - 72h; average drainage was （90.9±32.6）ml after operation; no patients received second operation due to active bleeding;the drainage tubes were withdrew within 48h after operation;no sedatives were required due to pain and wounds were healed well. Postoperative crisis appeared in 21 cases,among which 18 eases were cured and 2 spontaneously discharged and I died. All the patients received a follow-up of 6 - 82 months except 6 eases. No sternal malunion was found. Complete remission rate was 46.8% （227/485） and partial remission rate was 40.9%（198/485） with a total effective rate of 87.7% （ 425/485 ）. Conclusion It is a plastic surgery with microinvasion , with sooner recovery and better clinic results by implementing enlarged thymeetomy of transverse sternal mieroinvasive incision at 2nd intereostals space after sufficient preparation.

关 键 词：重症肌无力 胸腺切除术 胸外科 微创 

分 类 号：R655[医药卫生—外科学]