单操作孔胸腔镜与传统胸腔镜下胸腺扩大切除治疗重症肌无力的对比研究  

A comparative study on the efficacy of extended thymectomy for myasthenia gravis:single-utility port versus traditional video-assisted thoracoscopic approaches

作　　者：黄川 孙耀光[1] 吴青峻[1] 马超[1] 焦鹏[1] 田文鑫[1] 于瀚博 黄文[1] 王永忠[1] 佟宏峰[1] HUANG Chuan;SUN Yaoguang;WU Qingjun;MA Chao;JIAO Peng;TIAN Wenxin;YU Hanbo;HUANG Wen;WANG Yongzhong;TONG Hongfeng(不详;Department of Thoracic Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730.China)

机构地区：[1]北京医院胸外科,国家老年医学中心,中国医学科学院老年医学研究院,100730

出　　处：《中国神经免疫学和神经病学杂志》2020年第4期281-286,共6页Chinese Journal of Neuroimmunology and Neurology

摘　　要：目的探讨单操作孔胸腔镜胸腺扩大切除治疗重症肌无力(myasthenia gravis,MG)的手术安全性和临床疗效。方法回顾性分析2017年1月至2019年3月北京医院胸外科经单操作孔胸腔镜(单操作孔组)和传统三孔法胸腔镜(三孔组)行胸腺扩大切除术治疗MG的患者,比较两组患者的临床资料、手术安全指标和疗效。结果本研究共入组MG 104例,其中单操作孔组51例,三孔组53例。两组均无中转开胸和围术期死亡,三孔组中1例术后当日因胸廓内动脉出血二次胸腔镜探查止血。单操作孔组手术时间稍长于三孔组〔(142.25±42.78)min比(125.85±37.76)min,P=0.04〕,两组术中出血量(50 mL比50 mL,P=0.249)、胸腔引流量〔(836.47±441.19)mL比(930.47±498.75)mL,P=0.312〕、胸管留置时间(3 d比3 d,P=0.114)、术后住院时间(6 d比7 d,P=0.619)、围术期总体并发症(27.45%比28.30%,P=0.923)、肌无力危象(11.76%比16.98%,P=0.449)、切口并发症(7.84%比9.43%,P=0.773)的差异无统计学意义。单操作孔组术后第1、2、3天疼痛评分低于三孔组(P<0.05),术后镇痛药物使用率低于三孔组(27.45%比50.94%,P<0.05)。全组随访率98.08%,中位随访时间24.2个月(11.2~38.1个月),两组术后1年有效率(90.20%比88.24%,P=0.750)的差异无统计学意义。结论单操作孔胸腔镜胸腺扩大切除治疗MG的手术安全性和疗效良好,有助于降低术后疼痛。肌无力危象、肺部并发症、切口并发症和术后疼痛仍是影响MG患者围术期安全和生活质量的重要因素,围术期应注意预防以上并发症,从而提高治疗安全性和有效率。Objective To evaluate the safety and efficacy of single-utility port video-assisted thoracoscopic(VATS)extended thymectomy for myasthenia gravis(MG).Methods A retrospective analysis was performed on MG patients who underwent VATS extended thymectomy via single-utility port approach(single-utility port group)and traditional three ports approach(three ports group)in Beijing Hospital from January 2017 to March 2019.Clinical data,perioperative safety and efficacy were compared between the two groups.Results One hundred and four patients were enrolled in this study,including 51 patients in the single-utility port group and 53 patients in the three ports group.There was no conversion to thoracotomy or postoperative death in neither groups.One patient in the three ports group undergone thoracoscopic hemostasis due to hemorrhage of the internal thoracic artery.The operation time of single-utility port group was slightly longer than that of the three ports group[(142.25±42.78)min vs.(125.85±37.76)min,P=0.04].There was no significant difference of intraoperative blood loss(50 mL vs.50 mL,P=0.249),postoperative pleural drainage[(836.47±441.19)mL vs.(930.47±498.75)mL,P=0.312],postoperative thoracic drainage duration(3 d vs.3 d,P=0.114),postoperative hospital stay(6 d vs.7 d,P=0.619),perioperative complications(27.45%vs.28.30%,P=0.923),myasthenic crisis(11.76%vs.16.98%,P=0.449)and incision complications(7.84%vs.9.43%,P=0.773)between the two groups.The single-utility port group had lower visual analogue score of pain on the first,second and third day after surgery(P<0.05),and the proportion of postoperative analgesic usage was lower than that in the three ports group(27.45%vs.50.94%,P<0.05).The follow-up rate was 98.08%,and the median follow-up time was 24.2 months(11.2 months to 38.1 months).There was no significant difference of effective rate of MG between the two groups(90.20%vs.88.24%,P=0.750).Conclusions Single-utility port thoracoscopic extended thymectomy is a safe and effective procedure for MG,which helps reduce

关 键 词：重症肌无力 胸腺扩大切除 电视胸腔镜 单操作孔 

分 类 号：R746.1[医药卫生—神经病学与精神病学]