达芬奇机器人与电视胸腔镜治疗胸腺瘤合并重症肌无力的效果  

The study of clinical outcomes of extended thymectomy by robotic and video assisted thoracoscopic surgey for thymoma with myasthenia gravis

作　　者：薛志强[1] 初向阳[1] 张连斌[1] 杨博[1] 温佳新[1] 李彤[1] 刘阳[1] 

机构地区：[1]中国人民解放军总医院胸外科,北京100853

出　　处：《中华胸心血管外科杂志》2017年第3期141-143,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨达芬奇机器人、电视胸腔镜（VATS）治疗胸腺瘤合并重症肌无力（MG）的临床效果.方法 回顾性分析2013年6月至2016年6月在我院行手术治疗的胸腺瘤合并MG患者临床病理资料,比较达芬奇机器人、VATS与纵劈胸骨手术的临床疗效.结果 41例胸腺瘤合并MG手术患者中采用达芬奇机器人8例、VATS 13例、纵劈胸骨20例,切除范围包括肿瘤在内的前纵隔胸腺、脂肪组织.机器人组与胸腔镜组的手术时间、术中出血量、术后胸管时间、住院时间、术后并发症、术后肌无力危象差异均无统计学意义（P＞0.05）.胸腔镜组、机器人组的术中出血量均显著少于纵劈胸骨组（P＜0.05）,胸腔镜组术后胸管时间显著低于纵劈胸骨组（P＜0.05）.3组MG患者术后有效比例分别为65.0％、69.2％、62.5％,组间差异无统计学意义（P＞0.05）.结论 达芬奇机器人和VATS胸腺扩大切除是治疗胸腺瘤并发MG安全、可靠的微创手术方法,临床疗效与纵劈胸骨手术相似.Objective To study the clinical outcomes of robotic extended thymectomy and thoracoscopic extended thymectomy for thymoma patients with myasthenia gravis compared with conventional median sternotomy extended thymectomy.Methods The clinical data of thymoma patients with myasthenia gravis treated by extended thymectomy between June 2013 and June 2016 were retrospectively reviewed.The clinical outcome parameters were compared according to surgical approach.Results 41 thymoma patients with myasthenia gravis,8 cases underwent robotic extended thymecotmy,11 cases underwent thoracoscopic extended thymectomy and 20 underwent median sternotomy extended thymectomy.The resected extension included tumor,thymus tissue and adipose tissue in anterior mediastinum.There were no significant differences between robotic group and thoracoscopic group regarding operative time,blood loss,chest tube duration,hospital stay,postoperative complications and postoperative myasthenic crisis （P 〉 0.05）.The blood loss of robotic group and thoracoscopic group was significantly lower than that in median sternotomy group（P 〈 0.05）.The chest tube duration of thoracoscopic group was significantly shorter than that in median sternotomy group（P 〈0.05）.The effective rates of MG after extended thymectomy in robotic group,thoracoscopic group and sternotomy group was 65.0% 、69.2% 、62.5% respectively and there was no significant difference （P 〈 0.05）.Conclusion Robotic thymectomy and thoracoscopic thymecotomy are both minimal invasive surgery approach with less bleeding for thymoma patients with myasthenia gravis.The clinical outcomes of robotic thymectomy and thoracoscopic thymecotomy are similar.

关 键 词：机器人手术 电视胸腔镜手术 胸腺瘤 重症肌无力 

分 类 号：R736.3[医药卫生—肿瘤] R746.1[医药卫生—临床医学]