剑突下胸腔镜胸腺切除术的安全性和可行性研究  

Safety and Feasibility Study of Subxiphoid Thoracoscopic Thymectomy

作　　者：江文坛[1] 杨建胜 林良安[1] 吴敬阳 林贤宾 JIANG Wentan;YANG Jiansheng;LIN Liang'an;WU Jingyang;LIN Xianbin(Department of Thoracic Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000,China)

机构地区：[1]福建医科大学附属第二医院胸外科,泉州362000

出　　处：《福建医科大学学报》2020年第1期40-43,共4页Journal of Fujian Medical University

基　　金：泉州市科技计划项目(2018Z101)。

摘　　要：目的探讨剑突下胸腔镜胸腺切除治疗胸腺肿瘤及重症肌无力(MG)的安全性和可行性。方法回顾性分析54例接受胸腔镜胸腺切除术患者的临床资料,其中剑突下胸腔镜胸腺切除术27例,经肋间胸腔镜胸腺切除术27例,分析比较两组的临床指标、术后疼痛评分及并发症等情况。结果所有患者均顺利实施手术,无术中麻醉意外情况出现,剑突下组无中转开胸,肋间组中转开胸1例。剑突下组的手术时间、术中出血量、术后胸液量及胸管留置时间,与肋间组比较差别无统计学意义(P>0.05);剑突下组术后住院时间明显少于肋间组,分别为(4.22±1.99)d和(7.44±2.12)d,两组比较差别有统计学意义(P<0.05);剑突下组术后24,48,72 h疼痛视觉模拟评分(VAS)明显低于肋间组,分别为(2.52±0.85),(1.74±0.81),(1.33±0.73)分和(3.74±1.97),(2.63±1.80),(2.00±1.57)分,两组各时间点比较差别均有统计学意义(P<0.05);剑突下组围术期并发症低于肋间组,分别为7.4%和18.5%,但差别无统计学意义(P>0.05)。结论剑突下胸腔镜胸腺切除术安全、可行,具有疼痛轻、恢复快等优点,是治疗胸腺肿瘤和MG较为完美的手术方法,适合推广。Objective To explore the safety and feasibility of subxiphoid thymectomy for thymic tumor and myasthenia gravis.Methods A retrospective analysis was made of 54 patients who underwent thoracoscopic thymectomy since 2014.Among them,27 underwent subxiphoid thymectomy and 27 underwent intercostal thymectomy.The clinical indicators,post-operative pain scores,and complications of the two groups were analyzed.Results All operations were carried out smoothly.No intraoperative anesthesia accident occurred.There was no conversion to thoracotomy in subxiphoid group and there was 1 case of the conversion in intercostal group.There was no significant difference in operation time,intraoperative bleeding volume,postoperative pleural fluid volume,and thoracic tube indwelling time between the subxiphoid group and the intercostal group(P>0.05).The hospitalization time in the subxiphoid group was significantly shorter than that in the intercostal group[(4.22±1.99)days vs(7.44±2.12)days],and the difference was significant(P<0.05).The VAS scores of Subxiphoid group at 24,48,and 72 hours after operation were significantly lower than those in the intercostal group[(2.52±0.85),(1.74±0.81),and(1.33±0.73)vs(3.74±1.97),(2.63±1.80),and(2.00±1.57)].The differences between the two groups were signifcant(P<0.05).Perioperative complications in Subxiphoid group were lower than those in intercostal group(7.4%vs 18.5%),but there was no significant difference(P>0.05).Conclusion Subxiphoid thymectomy is safe and feasible,with light pain and quick recovery.It is a relatively perfect surgical method for thymic tumor and myasthenia gravis.

关 键 词：胸腔镜 剑突 胸腺切除术 胸腺肿瘤 重症肌无力 

分 类 号：R655[医药卫生—外科学] R655.3[医药卫生—临床医学]