经剑突下与经肋间胸腺扩大切除术治疗重症肌无力的回顾性队列研究  

Subxiphoid versus intercostal video-assisted thoracoscopic extended thymectomy for myasthenia gravis:A retrospective cohort study

作　　者：郑文龙 张淼 武文斌 张辉 张昕辉 ZHENG Wenlong;ZHANG Miao;WU Wenbin;ZHANG Hui;ZHANG Xinhui(Affiliated Xuzhou Clinical College of Xuzhou Medical University,Xuzhou Central Hospital,Xuzhou,221009,Jiangsu,P.R.China)

机构地区：[1]徐州医科大学徐州临床学院徐州市中心医院,江苏徐州221009

出　　处：《中国胸心血管外科临床杂志》2023年第6期835-841,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的比较经剑突下胸腔镜(subxiphoid video-assisted thoracoscopic surgery,XVATS)与经肋间VATS(conventional intercostal VATS,CVATS)胸腺扩大切除术治疗重症肌无力(myasthenia gravis,MG)的临床疗效。方法回顾性分析2016年10月—2021年10月徐州市中心医院胸外科行胸腺扩大切除术MG患者的临床资料。筛选有疗效随访评价的病例,依据手术方式分为XVATS组与CVATS组。比较两组患者围术期指标及临床效果。结果共纳入患者84例,其中男43例、女41例,平均年龄52.3岁。XVATS组41例,CVATS组43例。全组患者无死亡、心肺血栓、肺漏气或纵隔内感染。CVATS组5例(11.6%)中转开胸、1例(2.3%)术后MG危象、1例(2.3%)胸腔内出血、1例(2.3%)乳糜胸。两组在手术时间[(127.4±50.4)min vs.(122.9±38.6)min]、术中出血量[46.9(25.7,79.2)mL vs.45.7(21.9,92.1)mL]、手术并发症发生率[0 vs.7.0%(3/43)]、胸腔引流管留置时间[(4.3±1.9)d vs.(4.8±2.8)d]、术后随访时间[(19.1±8.5)个月vs.(22.5±13.7)个月]、术后纵隔脂肪残留率[12.2%(5/41)vs.4.7%(2/43)]、MG术后总有效率[29.3%(12/41)vs.51.2%(22/43)]等方面差异均无统计学意义(P>0.05)。两组中转开胸率[0 vs.11.6%(5/43),P=0.024]、术后住院时间[(8.2±3.3)d vs.(11.4±5.8)d,P=0.003]、术后引流量[396.7(173.8,542.5)mL vs.218.8(102.1,430.0)mL,P=0.038]差异有统计学意义。结论XVATS胸腺扩大切除术安全、可行,但能否作为治疗MG的标准术式仍需进一步探讨。Objective To compare the clinical efficacy of subxiphoid video-assisted thoracoscopic surgery(XVATS)and conventional intercostal VATS(CVATS)extended thymectomy for myasthenia gravis(MG).Methods The clinical data of MG patients who underwent extended thymectomy in the Department of Thoracic Surgery of Xuzhou Central Hospital from October 2016 to October 2021 and finished the follow-up were retrospectively reviewed.They were divided into an XVATS group and a CVATS group according to the procedure.The perioperative variables and clinical efficacy of the two groups were compared.Results A total of 84 patients were collected,including 43 males and 41 females,with a mean age of 52.3 years.There were 41 patients in the XVATS group and 43 patients in the CVATS group.There was no mortality,cardiopulmonary thrombosis,prolonged air leak,or mediastinal infection.Additionally,the CVATS group recorded 5(11.6%)patients of conversion to open thoracotomy,1(2.3%)patient of postoperative MG crisis,1(2.3%)patient of bleeding in thorax,and 1(2.3%)patient of chylothorax.The operation time(127.4±50.4 min vs.122.9±38.6 min),intraoperative bleeding[46.9(25.7,79.2)mL vs.45.7(21.9,92.1)mL],incidence of complications[0 vs.7.0%(3/43)],chest tube duration(4.3±1.9 d vs.4.8±2.8 d),follow-up time(19.1±8.5 months vs.22.5±13.7 months),the proportion of residual mediastinal fat tissue[12.2%(5/41)vs.4.7%(2/43)],and total MG remission rate[29.3%(12/41)vs.51.2%(22/43)]were not statistically different between the two groups(P>0.05).However,the two groups showed significantly different incidence of conversion to open thoracotomy[0 vs.11.6%(5/43),P=0.024],postoperative hospital stay time(8.2±3.3 d vs.11.4±5.8 d,P=0.003)and total drainage volume[396.7(173.8,542.5)mL vs.218.8(102.1,430.0)mL,P=0.038].Conclusion XVATS extended thymectomy is technically safe and feasible;however,more evidence is warranted before the recommendation of this approach for the treatment of MG.

关 键 词：剑突下 胸腔镜手术 胸腺扩大切除术 重症肌无力 

分 类 号：R746.1[医药卫生—神经病学与精神病学]