纵隔肿物合并重症肌无力的外科治疗:达芬奇机器人、胸腔镜与胸骨正中切口手术对比研究  

Surgical treatment of mediastinal tumors combined with myasthenia gravis:comparison of Da Vinci robot-assisted, video-assisted thoracoscopic surgery and median sternotomy

作　　者：康云腾 许世广[1] 刘博[1] 王希龙[1] 徐惟[1] 丁仁泉[1] 李博[1] 王通[1] 刘星池[1] 孟浩[1] 滕洪[1] 王述民[1] KANG Yunteng;XU Shiguang;LIU Bo;WANG Xilong;XU Wei;DING Renquan;LI Bo;WANG Tong;LIU Xingchi;MENG Hao;TENG Hong;WANG Shumin(Department of Thoracic Surgery,General Hospital of Shenyang Military Command,Shenyang,110000,P.R.China)

机构地区：[1]沈阳军区总医院胸外科,沈阳110000

出　　处：《中国胸心血管外科临床杂志》2018年第12期1027-1031,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：辽宁省科技厅基金面上项目(2015020431)

摘　　要：目的对比纵隔肿物合并重症肌无力的外科治疗方法。方法回顾性分析2010年1月至2017年12月我院分别通过达芬奇机器人、胸腔镜或胸骨正中切口行全胸腺切除、纵隔脂肪清除术53例患者的临床资料,其中男29例、女24例,年龄17～73岁。根据手术方式将患者分为三组:A组(机器人组,n=22),B组(胸腔镜组,n=12)和C组(胸骨正中切口组,n=19)。对比三组患者性别分布、年龄、术中失血量、手术时间、术后拔管时间、术后住院时间、重症肌无力Osserman分型和术后肌无力缓解率等方面。结果所有患者均无围手术期死亡。其中C组1例患者术后出现肌无力危象,积极治疗后好转;B组1例患者因术中损伤左侧无名静脉而中转开胸。与B组及C组相比,A组手术时间短、术中失血量少、术后第1 d引流量较少、拔管时间短,术后住院时间A组短于C组,且差异均有统计学意义,术后肌无力缓解率A组(88.9%)要高于B组(75.0%)和C组(76.9%),但差异无统计学意义。结论因为机器人独特的微创优势,在本研究中,应用达芬奇机器人行纵隔肿物扩大切除术的重症肌无力合并胸腺肿物患者,无论是从围手术期的一些指标还是术后短期肌无力缓解率来看均优于其余两组。虽然数据还需要远期效果及大量配对试验证实。但不可否认的是,机器人手术一定是未来微创外科的发展趋势。Objective To compare three surgical treatments for mediastinal mass with myasthenia gravis. MethodsRetrospective analysis was performed on the clinical data of 53 patients who underwent extended thymectomy between January2010and December2017in our hospital.There were 29 males and 24 females,aged17-73years.Patients were divided into three groups according to the surgical methods:a group A(video-assisted thoracoscopic surgery with the da Vinci robotic system,n=22),a group B(video-assisted thoracoscopic surgery,n=12)and a group C(median sternotomy,n=19).The gender distribution,age,intraoperative blood loss,operation time,postoperative extubation time, postoperative hospital stay,Osserman classification of myasthenia gravis,postoperative myasthenic remission rate,etc were compared in three groups.ResultsNo perioperative death was observed in 53 patients.One patient in the group C suffered from postoperative myasthenic crisis and improved after active treatment.One patient with video-assisted thoracoscopic surgery was converted to median sternotomy due to the infraoperative injury of the left brachiocephalic vein.Compared with the group B and group C,the group A had shorter operation time,less intraoperative blood loss and drainage on the first postoperative day and fewer days of extubation.Postoperative hospital stay was less in the group A than that in the group C(P<0.05).The postoperative myasthenic remission rate was higher in the group A than that in the other two groups,but there was no statistical difference.ConclusionBecause of the robot's unique minimally invasive advantage,in this study,the outcome of patients with myasthenia gravis treated with Da Vinci robots and thymectomy is better than that of the remaining two groups in terms of perioperative outcomes and myasthenic remission rate.But long-term results and a large of number matching experiments are needed to confirm.However,it is undeniable that robotic surgery must be the future of the minimally invasive surgery.

关 键 词：重症肌无力 胸腺扩大切除术 机器人手术 胸腔镜 胸骨正中切口 

分 类 号：R655[医药卫生—外科学]