电视胸腔镜与经胸骨胸腺切除治疗不伴胸腺瘤重症肌无力的临床分析  

Clinical analysis of video-assisted thoracoscopic surgery and transsternal thymectomy for myasthenia gravis without thymoma

作　　者：宋阳[1] 陈刚[1] 伍宁[1] 吕会斌 朱勇俊[1] 苗锋[1] 庞烈文[1] 赵重波[3] 陈志明[1] 

机构地区：[1]复旦大学附属华山医院心胸外科,上海200040 [2]喀什地区第二人民医院心胸外科,844000 [3]复旦大学附属华山医院神经内科,上海200040

出　　处：《中华胸部外科电子杂志》2015年第3期182-187,共6页CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition

摘　　要：目的比较电视胸腔镜下胸腺切除术与经胸骨（胸骨正中切口、第2肋间胸骨横断小切口）胸腺切除术治疗不伴胸腺瘤重症肌无力的手术方法和远期疗效。方法2000年1月1日至2013年12月31日，复旦大学附属华山医院诊断为熏症肌无力伴胸腺增生的手术患者共355例，对其中272例回馈随访结果的患者进行回顾性分析研究，其中胸腔镜组58例，胸骨正中纵行劈开组23例，第2肋间胸骨横断小切口组191例。结果与胸骨正中纵行劈开组相比，胸腔镜组术中出血量少[（96．90±47．69）mlvs（152．30±93．19）ml，χ2=3．497，P〈0．001]、引流时间短[（1．93±o．97）dvs（2．61士0．94）d，t＝2．857，P=0．006]、住院时间短[（3．48±1．68）dvs（8．04±4．23）d，t=6．993，P〈0．001]。与第2肋间胸骨横断小切口组比，胸腔镜组引流时间短[（1．93±0．97）dvs（2．75±0．97）d，t=5．612，P〈0．001]、住院时间短[（3．48±1．68）dvs（6．87±4．16）d，t=6．042，P〈0．001]。术后随访12-76个月，平均随访时间为55个月。三组患者手术对重症肌无力的总效率分别为79．3％、86．9％和85．3％，组间差异无统计学意义（χ2=0．638，P=0．424；χ2=1．200，P=0．273）。结论电视胸腔镜下胸腺切除术不仅具有切口小、术中出血量少、术后恢复快、住院时间短等优点，还能够达到经胸骨手术切除胸腺治疗重症肌无力相似的临床效果。闪此，建议不伴胸腺瘤的重症肌无力患者手术应首选电视胸腔镜胸腺切除术。Objective To compare the surgical procedures and long-term clinical effects of thymeetomy for myasthenia gravis without thymoma between video-assisted thoracoscopic surgery （VATS） and transsternal surgery （median sternotomy and transverse sternotomy）. Methods Between January 1st 2000 and December 31st 2013, 355 patients with myasthenia gravis combined with thymic hyperplasia underwent surgery in Huashan Hospital, and retrospective study was conducated in 272 of those with follow-up results. Among these 272 patients, 58 received VATS（VATS group）, 23 received median sternotomy （median sternotomy group） and the other 191 received transverse sternotomy （transverse sternotomy group）. Results Compared with median sternotomy group, there was less bloodloss[（96.90±47.69）ml vs （152.30±93. 19）ml,χ2 =3.497, P〈0.001], shorter time of postoperative drainage [（1. 93±0. 97）d vs （2. 61±0. 94）d, t= 2. 857, P=0. 006] and shorter postoperative hospital stay in VATS group[（3.48± 1.68）d vs （8.04±4.23）d,t： 6. 993,P〈0. 001]. Compared with transverse sternotomy group, there was shorter time of postoperative drainage [（1.93±0.97）d vs （2.75±0.97）d,t= 5. 612,P〈0. 001] and shorter postoperative hospital stay in VATS group [（3.48±1.68）dvs （6.87±4.16）d,t=6.042,P〈0.001]. Patients were followed up for 12 to 76 months, and the mean time of follow up was 55 months. The overall remission rates of VATS group, median sternotomy group and transverse sternotomy group were 79. 3%, 86. 90% and 85. 3%, respectively, and there was no significant difference among three groups（χ2= 0. 638, P = 0. 424; χ2= 1.200, P=0.273）. Conclusions Thymectomy for myasthenia gravis without thymoma by VATS has the advantages of small incision, less blood loss, fast postoperative recovery and shorter postoperative hospital stay, and also has the same clinical effect as transsternal surgery. Therefore, VATS is preferable for the treatment of myasthenia gravis without thymoma.

关 键 词：重症肌无力 电视胸腔镜 胸骨正中切口 胸骨横断切口 手术入路 

分 类 号：R746.1[医药卫生—神经病学与精神病学]