横断胸骨扩大胸腺切除治疗全身型重症肌无力  

Transverse sternotomy extended thymectomy for generalized myasthenia gravis

作　　者：陈刚[1] 陈志明[1] 马勤运[1] 陈佶[1] 朱勇俊[1] 苗峰[1] 伍宁[1] 庞烈文[1] 

机构地区：[1]复旦大学附属华山医院胸心外科,上海200040

出　　处：《中华胸部外科电子杂志》2014年第1期17-22,共6页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

摘　　要：目的探讨经横断胸骨入路行扩大胸腺切除治疗重症肌无力的临床疗效。了解该入路的特点及临床疗效有助于该领域胸外科医师在临床实践中进行更好的临床决策。方法对1998至2008年在复旦大学附属华山医院胸心外科行横断胸骨治疗全身型重症肌无力的211例患者的临床资料进行回顾性研究，分析患者术中和术后基本情况。并对术后5年进行随访的患者根据是否合并胸腺瘤进行分组，采用x2检验比较两组间的疗效。结果经横断胸骨入路能满足对合并Masaoka-KogaI期及Ⅱ期胸腺瘤患者及无瘤患者实施扩大胸腺切除的需要，手术并发症较低，便于围术期护理，恢复迅速。对173例患者进行术后5年随访，总缓解率达到79．8％（138／173），无肿瘤复发。合并胸腺瘤组的总缓解率为81．9％（59／72），未合并胸腺瘤组的总缓解率为78．2％（79／101），两组间比较差异无统计学意义（x2=0．362，p=0．548）。结论与其他常用手术入路相比，横断胸骨入路的特点值得该领域胸外科医师关注。Objective To investigate the clinical outcomes ot transverse sternotomy extenucu thymectomy for myasthenia gravis. Further understanding about the merits and incompetence of this approach may help to make clinical decisions. Methods The clinical data of 211 patients undergoing transverse sternotomy for generalized myasthenia gravis between 1998 and 2008 in Department of Cardiothoracic Surgery, Huashan Hospital affiliated to Fudan University were retrospectively studied, and the basic conditions during and after operation were analysed. The clinical outcomes were compared by X2 test between patients with thyrnoma and those without thymorna after follow-up for 5 years. Results Transverse sternotomy was an effective approach for nonthymomatous and Masaoka-Koga stage I or stageⅡthymatous patients, with less complications. It was convenient for intraoperative manipulation and perioperative management. Patients had a quick recovery with minimum discomfort. After follow-up for 5 years in 173 patients, the overall remission rate for myasthenia gravis was 79. 8 % （138/173）, with no recurrence. The overall remission rates of patients with thymoma and those without thymoma were 81.9%（59/72） and 78. 2% （79/101）, respectively, and there was no significarat differences between them （x2 = 0. 362, P= 0. 548）. Conclusion Transverse sternotomy approach can be considered in the treatment of myasthenia gravis when other options are less preferred,

关 键 词：重症肌无力 胸腺切除术 手术入路 

分 类 号：R746.1[医药卫生—神经病学与精神病学]