摘要
目的分析胸腔镜剑突肋缘下及纵劈胸骨胸腺扩大切除术治疗重症肌无力合并胸腺瘤的临床疗效、安全性及可行性。方法回顾性分析2011年12月—2021年12月在空军军医大学唐都医院胸外科同一诊疗组行手术治疗的重症肌无力合并胸腺瘤患者的临床资料,按照手术入路分为胸腔镜剑突肋缘下胸腺扩大切除术组(胸腔镜组)和纵劈胸骨胸腺扩大切除术组(纵劈组)。比较两组患者的临床资料。结果共纳入456例患者,其中纵劈组51例,男30例、女21例,年龄23~66(49.5±11.8)岁;胸腔镜组405患者经倾向性评分匹配后纳入51例患者,男28例、女23例,年龄26~70(47.2±12.2)岁。两组均顺利完成手术,胸腔镜组无术中转开胸。胸腔镜组在手术时间、术中出血量、胸腔引流时间、术后住院时间、患者满意度评分、疼痛评分、并发症方面优于纵劈组(P<0.05)。两组在术中淋巴结清扫站数、术中淋巴结清扫枚数、术后肌无力缓解情况方面差异无统计学意义(P>0.05)。结论对于重症肌无力合并胸腺瘤患者,胸腔镜剑突肋缘下胸腺扩大切除术的手术彻底性、安全性不亚于纵劈胸骨术式,但其更加微创化,是一种有效的手术方式。
Objective To compare clinical effects of enlarged thymectomy for the treatment of myasthenia gravis(MG)complicated with thymoma via subxiphoid and subcostal arch thoracoscopic resection versus median sternotomy resection.Methods We retrospectively analyzed the clinical data of patients with MG complicated with thymoma admitted in Tangdu Hospital of the Air Force Military Medical University between December 2011 and December 2021.Patients who underwent subxiphoid and subcostal arch thoracoscopic enlarged thymectomy were allocated to a SR group,and patients who underwent median sternotomy enlarged thymectomy were allocated to a MR group.Perioperative outcomes were compared between the two groups.Results A total of 456 patients were collected.There were 51 patients in the MR group,including 30 males and 21 females aged 23-66(49.5±11.8)years.There were 405 patients in the SR group,among whom 51 patients were matched to the MR group by propensity score matching,including 28 males and 23 females aged 26-70(47.2±12.2)years.The operations were accomplished successfully in all patients,and no conversion to thoracotomy occurred in the SR group.The SR group had advantages in the operation time,intraoperative blood loss,chest drainage duration,hospital stay time,patients’satisfaction level,pain score and complications(all P<0.05).No statistical difference was found in the number of intraoperative lymph node dissection stations,number of intraoperative lymph nodes dissected or remission of MG between the two groups(P>0.05).Conclusion Subxiphoid and subcostal arch thoracoscopic enlarged thymectomy and lymphadenectomy is a safe,effective and feasible minimally invasive procedure for the treatment of MG complicated with thymoma.
作者
尹逊亮
赵正维
程少毅
冯征
郭一泽
张天翼
薛沙
周勇安
YIN Xunliang;ZHAO Zhengwei;CHENG Shaoyi;FENG Zheng;GUO Yize;ZHANG Tianyi;XUE Sha;ZHOU Yong'an(Department of Thoracic Surgery,Tangdu Hospital of the Air Force Military Medical University,Xi’an,710038,P.R.China;Department of Anesthesiology,The Second Affiliated Hospital of Xi’an Medical College,Xi’an,710038,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2023年第6期824-829,共6页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
陕西省重点研发计划(2017ZDXM-SF-052)。
关键词
重症肌无力
胸腺瘤
胸腔镜手术
剑突肋缘下
纵劈胸骨
Myasthenia gravis
thymoma
video-assisted surgery
subxiphoid approach
median sternotomy
