全胸腺切除与胸腺瘤切除治疗早期非重症肌无力胸腺瘤的围术期指标和预后比较  

Complete thymectomy versus thymomectomy in treatment of early non-myasthenia gravis thymoma:perioperative outcomes and prognosis

作　　者：井淼 蔡文涵 温佳新[2] 高杰[3] 吴重重[4] 薛志强[2] JING Miao;CAI Wenhan;WEN Jiaxin;GAO Jie;WU Chongchong;XUE Zhiqiang(Chinese PLA Medical School,Beijing 100853,China;Department of Thoracic Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Pathology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Radiology,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军医学院,北京100853 [2]解放军总医院第一医学中心胸外科,北京100853 [3]解放军总医院第一医学中心病理科,北京100853 [4]解放军总医院第一医学中心放射诊断科,北京100853

出　　处：《解放军医学院学报》2022年第5期502-506,共5页Academic Journal of Chinese PLA Medical School

基　　金：解放军总医院医疗大数据项目(2019MBD-017)。

摘　　要：背景全胸腺切除是胸腺瘤外科治疗的推荐切除范围,但有观点认为,在早期非重症肌无力胸腺瘤的手术治疗中,保证肿瘤完整切除的前提下,对正常胸腺组织的切除与否可不做要求。目的探讨不同切除范围治疗早期非重症肌无力胸腺瘤的疗效和预后。方法回顾性分析2010年1月-2019年12月在解放军总医院第一医学中心接受手术治疗的胸腺瘤患者资料,选择Ⅰ、Ⅱ期的非重症肌无力患者,根据术中切除范围分成为胸腺切除组和胸腺瘤切除组,通过倾向评分匹配均衡组间协变量,对比分析两组患者临床结果和预后。结果共有321例患者纳入研究,其中全胸腺切除组205例,胸腺瘤切除组116例,经过倾向评分匹配后,各有101例纳入研究。其中胸腺瘤切除组52.2岁,男性53例,女性48例;全胸腺切除组51.6岁,男性47例,女性54例。胸腺瘤切除组的手术时间显著短于胸腺切除组(97 min vs 120 min,P<0.001),其余围术期指标差异无统计学意义(P>0.05)。胸腺瘤切除组与胸腺切除组的10年无复发生存率、无病生存率差异均无统计学意义(97.7%vs 96.3%,P>0.05;96.1%vs 91.8%,P>0.05)。结论相比于胸腺切除,胸腺瘤切除是一种创伤更小的手术策略,在早期非重症肌无力胸腺瘤预后方面也具有相当的可靠性。Background Complete thymectomy has classically been regarded as the standard treatment protocol for thymoma.However,several authors have pointed out that the optimal mode of resection for thymoma in early-stage patients without myasthenia gravis is still controversial,one of the debates is that thymomectomy may be an alternative treatment option.Objective To compare the perioperative outcomes,survival,and recurrence between patients undergoing thymectomy versus thymomectomy.Methods From January 2010 to December 2019,clinical data about 321 non-myasthenic patients underwent surgery for stageⅠandⅡthymomas in the First Medical Center of Chinese PLA General Hospital were retrospectively analyzed.Patients were divided into thymomectomy group(n=116)and thymectomy group(n=205).The two groups were matched by propensity score matching to balance the covariates.Surgical and oncologic outcomes were compared.Results After propensity score matching(PSM),101 patients in each group were included in the study.The thymomectomy group included 53 males and 48 females,with an average age of 52.2 years old;the thymectomy group included 47 males and 54 females,with an average age of 51.6 years old.The operation time of the thymomectomy group was significantly shorter than that of the thymectomy group(97 min vs 120 min,P<0.001).There was no significant difference in other perioperative outcomes(P>0.05).The 10-year freedom from recurrence(FFR)rate and disease-free survival(DFS)rate of the thymomectomy group were 97.7%,96.1%,respectively,and they were 96.3%and 91.8%in the thymectomy group,indicating no significant difference between the two groups(P>0.05,respectively).Conclusion Thymomectomy is not inferior to thymectomy with respect to oncological outcomes,but it has better perioperative outcomes,suggesting that it may be a viable treatment option for early stage thymoma.

关 键 词：胸腺瘤 全胸腺切除 胸腺瘤切除 无复发生存率 无进展生存率 

分 类 号：R746.1[医药卫生—神经病学与精神病学]