胸腔镜剑突肋缘下与纵劈胸骨手术治疗重症肌无力临床疗效对比

摘要

目的 探讨并评价胸腔镜剑突肋缘下前纵隔病变切除术的临床疗效.方法 回顾性分析2011年12月至2016年12月在空军军医大学唐都医院胸外科同一诊疗组接受手术治疗的528例重症肌无力患者临床资料,按照手术入路分为胸腔镜剑突肋缘下前纵隔病变切除术组(胸腔镜组,402例)和纵劈胸骨前纵隔病变切除术组(纵劈胸骨组,126例).经倾向评分匹配,胸腔镜组获得与纵劈胸骨组相同的126例患者.对比分析两组手术时间、术中出血量、胸腔引流时间、术后住院时间、术后肌无力缓解情况、患者满意情况、疼痛情况及并发症等指标.结果 两组均顺利完成手术,胸腔镜组无术中转开胸.纵劈胸骨组、腔镜组在手术时间[(106.3 ±32.7)min对(53.2 ±37.3) min]、术中出血量[(138.2±26.7)ml对(38.2±10.3)ml]、胸腔引流时间[(3.3±1.6)天对0天]、术后住院时间[(5.0±2.5)天对(2.5±1.8)天]、患者满意度评分(6.1±2.3对8.9±1.2)、疼痛评分、术后切口感染发生率(4.8％对0.8％)和肌无力危象发生率(7.1％对1.6％)等方面差异均有统计学意义(P＜0.05).两组在术后肌无力缓解、总体并发症方面差异均无统计学意义(P＞0.05).结论 胸腔镜剑突肋缘下前纵隔病变切除术治疗合并前纵隔病变的重症肌无力,手术彻底性不劣于纵劈胸骨术式,但其更加微创化,是一种有效的手术方式.%Objective To compare and analyze clinical effects of extended thymectomy for the treatment of thymoma with myasthenia gravis(MG) between subxiphoid and subcostal arch thoracoscopic resection(SR) and the median sternotomy(MS) with a propensity-matched analysis.Methods We retrospectively analyzed 528 patients presented with MG and admitted in Tangdu Hospital of Air Force Military Medical University from December 2011 to December 2016,among whom 402 underwent subxiphoid and subcostal arch thoracoscopic extended thymectomy(SR group) and 126 median sternotomy(MS group).Another 126 patients were produced by a propensity-matched analysis in these 402 patients,to match with MS group.Perioperative outcomes were compared between SR group and MS group.Results All operations were accomplished successfully,without conversion to thoracotomy in SR group.Most postoperative outcomes were equal in remission of MG and postoperative complication between the two groups(P ＞ 0.05).There were statistical differences between MS group and SR group in operation time [(106.3 ±32.7)min vs.(533.2 ±37.3) min],intraoperative blood loss[(138.2 ±26.7)ml vs.(38.2 ± 10.3) ml],chest drainage duration[(3.3 ± 1.6) days vs.0 day],hospital length of stay [(5.0 ± 2.5) days vs.(2.5 ± 1.8) days],patients'satisfaction level(6.1 ±2.3 vs.8.9 ± 1.2),the incidence of postoperative wound infections(4.8％ vs.0.8％),the incidence of myasthenic crisis(7.1％ vs.1.6％)and pain scores,all P ＜0.05.Conclusion Subxiphoid and subcostal arch thoracoscopic extended thymectomy is a safe and feasible minimally invasive procedure for tmanagement of MG with thymoma.