电视胸腔镜与经胸骨手术治疗重症肌无力伴胸腺瘤的临床对比研究  

A Comparative Study on Clinical Effect between Video-assisted Thoracoscopic Surgery and Transsternal Thymectomy for Myasthenia Gravis with Thymoma

作　　者：宋阳[1] 伍宁[1] 陈刚[1] 朱勇俊[1] 苗锋[1] 庞烈文[1] 陈志明[1] 

机构地区：[1]复旦大学附属华山医院心胸外科,200040

出　　处：《中国临床神经科学》2016年第2期179-185,共7页Chinese Journal of Clinical Neurosciences

摘　　要：目的比较重症肌无力(MG)伴胸腺瘤患者行胸腔镜胸腺切除和经胸骨胸腺切除术的疗效。方法回顾性分析2000至2014年276例行电视胸腔镜(电视胸腔镜组)、胸骨正中劈开(胸骨正中劈开组)和第二肋间胸骨横断小切口(胸骨横断小切口组)入路行胸腺扩大切除术的MG伴胸腺瘤患者的临床资料及其治疗效果。结果电视胸腔镜组的性别、年龄、病程、术前肺活量预计值、重症肌无力基金会分级和总有效率等数据与胸骨正中劈开组和胸骨横断小切口组比较,差异无统计学意义(P>0.05);而手术切口长度、留置引流管数、术后引流时间、术后住院时间、术后出现并发症的例数均显著低于胸骨正中劈开组和胸骨横断小切口组,差异有统计学意义(P>0.05)。结论虽然3种胸腺切除手术方式在治疗MG的总有效率方面差异无显著性,但胸腔镜手术患者的围手术期优势明显。Aim To compare the clinical effect of thymectomy for myasthenia gravis（MG） with thymoma between video-assisted thoracoscopic surgery（VATS） and transsternal surgery. Methods From 2000 to 2014, the clinical data of total 276 MG patients with thymoma were retrospectively analyzed. Results No significant difference was found in gender, age, duration of disease, estimated values of preoperative lung capacity, Myasthenia Gravis Foundation of America（MGFA） classification and remission rate of MG among the three groups（P〉0.05）. Compared with median sternotomy group and second transverse sternotomy group, VATS group showed a smaller incision, a smaller number of chest tubes, a shorter time of postoperative drainage, a shorter postoperative hospital stay, a lower rate of postoperative morbidity. There was significant difference between VATS group and other two groups（P〈0.05）. Conclusion Although the remission rate of MG was found no significant difference among the three groups, VATS group had obvious advantages than other two groups during the perioperative duration.

关 键 词：胸腔镜 第二肋间小切口 胸骨正中劈开 重症肌无力 胸腺瘤 

分 类 号：R746.1[医药卫生—神经病学与精神病学] R655.7[医药卫生—临床医学]