局部晚期胸腺切除术中保留膈神经的效果及预后分析  

Effect and prognosis of retaining phrenic nerve during local advanced thymotomy

作　　者：王旭[1] 袁五营[1] 徐文举 WANG Xu;YUAN Wu-ying;XU Wen-ju(Henan Chest Hospital,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院微创外科,郑州450000

出　　处：《医药论坛杂志》2020年第8期33-37,共5页Journal of Medical Forum

摘　　要：目的探讨在局部晚期胸腺切除术中采用保留膈神经手术方法对治疗效果及患者预后的影响。方法纳入河南省胸科医院在2015年1月至2018年1月收治的临床分期为Ⅲ期及以上的胸腺瘤患者64例,按照随机数字表法分为保留膈神经(PN)组和切除组,各32例,PN组进行胸腺瘤切除时保留膈神经,切除组切除肿瘤和膈神经,并随访4年,比较两组患者临床资料、生活质量、总生存期、无病生存期及手术并发症情况。结果两组间术中出血量、胸腔引流量及住院时间无统计学差异(P>0.05),手术时长PN组长于切除组(t=2.352,P=0.022),组间比较差异具有统计学意义;两组患者治疗前生活质量评分比较差异无统计学意义(P>0.05),治疗后PN组和切除组生活质量评分均优于治疗前,且治疗后PN组的社会功能、躯体疼痛、精神状态及总体健康评分均优于切除组,差异有统计学意义(P<0.05);所有患者治疗后进行24~48个月的随访, PN组有3例失访,切除组有2例失访。截止末次随访时间,PN组及切除组总生存率分别为90.63%(29/32例)和84.38%(27/32例),无病生存率分别78.13%(25/32例)和81.25%(26/32例),差异均无统计学意义(P>0.05)。PN组出现手术并发症28.13%(9例/32例),切除组出现手术并发症53.13%(17例/32例),PN组并发症发生率显著低于切除组(χ~2=4.146,P=0.042),差异有统计学意义。结论在局部晚期胸腺瘤切除术中保留膈神经可显著改善患者生活质量、减少术后并发症的发生,且不影响患者总生存期和无病生存期。Objective To investigate the effect of phrenic nerve sparing surgery on the outcome of local advanced thymectomy.Methods Totally 64 patients diagnosed thymoma with clinical stageⅢor above admitted to our hospital from January 2012 to January 2015 were included.According to the random number table method,they were divided into the PN group and the resection group,with 32 cases each.Phrenic nerve was retained during thymoma resection in the PN group,while tumor and phrenic nerve were removed in the resection group.After 4 years of follow-up,the clinical data,quality of life,overall survival,disease-free survival and surgical complications of the two groups were compared.Results There were no significant differences in intraoperative blood loss,thoracic drainage and length of stay between the two groups(P>0.05),the PN group’s operation time was longer than the resection group(t=2.352,P=0.022),There was no statistically significant difference in quality of life scores between the two groups before treatment(P>0.05).The quality of life scores of the PN group and the excision group after treatment were better than those before treatment,After treatment,the social function,physical pain,mental state and overall health scores of the PN group were better than those of the resection group(P<0.05).All patients were followed up for 48 months after treatment,3 cases were lost to follow-up in the PN group and 2 cases were lost to follow-up in the resection group.By the time of the last follow-up,the overall survival rates of the PN group and the resection group were 90.63%(29/32 cases)and 84.38%(27/32 cases),and the disease-free survival rates were 78.13%(25/32 cases)and 81.25%(26/32 cases),with no statistical significance(P>0.05).The incidence of complications in the PN group was 28.13%(9/32 cases),while that in the resection group was 53.13%(17/32 cases).The incidence of complications in the PN group was significantly lower than that in the resection group(P<0.05).Conclusion Retaining phrenic nerve during local advanced

关 键 词：胸腺瘤 膈神经 生活质量评分 预后 

分 类 号：R655.7[医药卫生—外科学]