[1]崔新征,方华①,杨鲲鹏,等.横断胸骨第2肋间小切口与胸骨正中切口行胸腺切除治疗重症肌无力的对比研究[J].中国微创外科杂志,2010,10(6):492-495.
　Cui Xinzheng*,Fang Hua,Yang Kunpeng*,et al.Comparison between Second Intercostal Transsternal Incision and Midsternal Incision in Thymectomy for Myasthenia Gravis[J].Chinese Journal of Minimally Invasive Surgery,2010,10(6):492-495.
点击复制

横断胸骨第2肋间小切口与胸骨正中切口行胸腺切除治疗重症肌无力的对比研究()
分享到：

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
10
期数:
2010年6期
页码:
492-495
栏目:
出版日期:
2010-07-01

文章信息/Info

Title:
Comparison between Second Intercostal Transsternal Incision and Midsternal Incision in Thymectomy for Myasthenia Gravis
作者:
崔新征; 方华①; 杨鲲鹏; 王铁栓; 朱利伟; 张清勇**
郑州大学第二附属医院胸外科，郑州450014
Author(s):
Cui Xinzheng*;  Fang Hua;  Yang Kunpeng*;  et al.
*Department of Thoracic Surgery, Second Affiliated Hospital, Zhengzhou University, Zhengzhou 450014, China
关键词:
重症肌无力; 胸腺切除术; 手术方法; 胸骨正中切开术
Keywords:
Myasthenia gravis; Thymectomy; Surgery; Median sternotomy
分类号:
R655;R746.1
文献标志码:
A
摘要:
目的比较横断胸骨第2肋间与胸骨正中切口行胸腺切除治疗重症肌无力的手术效果，以合理选择手术方式。方法回顾性分析1989年6月~2007年5月行胸腺切除术治疗633例重症肌无力患者的临床资料，根据不同的手术切口将其分为横断胸骨组（1989年6月~2007年5月，568例）和正中切口组（1989年6月~1996年5月，65例）。采用独立样本t检验分析手术时间、术中出血量、术后引流量、住院费用、术后住院时间等指标，采用χ2检验分析手术并发症、肌无力危象发生率。结果与正中切口组相比，横断胸骨组手术时间短［(71.1±14.4)min vs (110.0±11.7)min，t=8.829，P=0.000］，术中出血量少［(56.4±15.7)ml vs (100.1±11.3)ml，t=9.406，P=0.000］，胸腔引流时间短［(1.7±0.4)d vs (3.1±0.6)d，t=8.463，P=0.000］，引流量少［(87.6±23.9)ml vs (99.9±11.2)ml，t=2.213，P=0.033］，住院费用低［(11833.0±2167.2)元 vs (15333.0±4141.4)元，t=2.594，P=0.017］，术后住院时间短［(8.6±1.1)d vs (12.2±3.0)d，t=4.503，P=0.000］，手术切口短［(7.9±1.2)cm vs (17.3±4.8)cm，t=7.911，P=0.000］，切口感染发生率低［0%(0/568) vs 6.2%(4/65)，P=0000］，胸骨裂开发生率低［0%(0/568) vs 7.7%(5/65)，P=0.000］，肺部感染发生率低［0%(0/568) vs 3.1%(2/65)，P=0.010］，手术后住院期间肌无力危象发生率低［8.8%(50/568) vs 16.9%(11/65)， χ2=4.417，P=0.036］。2组术后第1年、第2年、第3年完全缓解率差异无显著性［21.8%(52/238) vs 19.5%(8/41)， χ2=0.113，P=0.737；28.2%(67/238) vs 268%(11/41)， χ2=0.030，P=0.862；31.9%(76/238) vs 31.7%(13/41)， χ2=0.001，P=0.977］。 结论横断胸骨第2肋间切口胸腺切除术治疗重症肌无力安全性好，手术时间短，创伤小，术中出血量少，胸腔引流和住院时间短，住院费用低，能降低术后肌无力危象和手术并发症的发生率，美观，而且横断胸骨组能取得正中切口组手术同样理想的治疗效果，值得临床推广。
Abstract:
ObjectiveTo compare the surgical results between thymectomies through second intercostal transsternal incision and midsternal incision in patients with myasthenia gravis (MG), so that to find out the proper operational method. MethodsFrom June 1989 to May 2007, totally 633 patients with MG received thymectomy in our department. According to the type of surgical incision, we divided the patients into transsternal (568 cases, received the operation between June 1989 and May 2007) and midsternal (65 cases, underwent the surgery from June 1989 to May 1996) groups. The clinical data including operation time, intraoperative blood loss, postoperative drainage, hospital cost, and postoperative hospital stay were recorded and analyzed by using independent samples t test; meanwhile, the rates of surgical complications and incidence of myasthenic crisis were analyzed by χ2 test.ResultsThe transsternal group showed significantly shorter operation time ［(71.1±14.4) min vs (110.0±11.7) min, t=8829, P=0.000］, less intraoperative blood loss ［(56.4±15.7) ml vs (100.1±11.3) ml, t=9.406, P=0.000］, shorter postoperative chest drainage time ［(1.7±0.4) d vs (3.1±0.6) d, t=8.463, P=0.000］, less drainage volume ［(87.6±239) ml vs (99.9±11.2) ml, t=2.213, P=0.033］, less hospital cost ［(11833.0±2167.2) RMB vs (15333.0±4141.4) RMB, t=2594, P=0.017］, shorter postoperative hospital stay ［(8.6±1.1) d vs (12.2±3.0) d, t=4.503, P=0.000］, shorter incisional length ［(7.9±1.2) cm vs (17.3±4.8) cm, t=7.911, P=0.000］, lower rates of incisional infection ［0% (0/568) vs 6.2%(4/65), P=0.000］, sternal cleft ［0% (0/568) vs 7.7% (5/65), P=0.000］, and lung infection ［0% (0/568) vs 3.1%(2/65), P=0.010］, as well as lower rates of postoperative myasthenic crisis ［8.8% (50/568) vs 16.9%(11/65), χ2=4.417, P=0.036］ than the midsternal group. Whereas, no significant difference was detected in the 1, 2, and 3year rate of complete remission between the two groups ［21.8% (52/238) vs 19.5%(8/41), χ2=0.113, P=0.737; 28.2% (67/238) vs 26.8% (11/41), χ2=0.030, P=0.862; and 31.9% (76/238) vs 31.7% (13/41), χ2=0.001, P=0.977; respectively］.ConclusionsThymectomy via second intercostal transsternal incision is a safe operation with short operation time, minor trauma, low volumes of blood loss and chest drainage, low hospital cost, and low rates of surgical complications and myasthenic crisis. Meanwhile, it shows same therapeutic and cosmetic results as the operation through midsternal incision.

参考文献/References:

[1]Gold R,SchneiderGold C.Current and future standards in treatment of myasthenia gravis.Neurotherapeutics,2008,5(4):535-541.
[2]Haniuda M.Thymectomy for autoimmune myasthenia gravis.Nippon Geka Gakkai Zasshi,2006,107(6):268-272.
[3]张海涛,刘德若,郭永庆,等.外科治疗重症肌无力的疗效分析.中华外科杂志,2007,45(22):1546-1548.
[4]Osserman KE.Myasthenia Gravis.New York:Grune & Stratton,1958.80-81.
[5]Jaretzki A,Steinglass KM,Sonett JR.Thymectomy in the management of myasthenia gravis.Semin Neurol,2004,24:49-62.
[6]谢春发,李章红,江柏青,等.电视胸腔镜辅助胸腺切除术.中国微创外科杂志,2005,5(8):621-622.
[7]Meyer DM,Herbert MA,Sobhani NC,et al.Comparative clinical outcomes of thymectomy for myasthenia gravis performed by extended transsternal and minimally invasive approaches.Ann Thorac Surg,2009,87(2):385-390.
[8]梁毅,姜海明,何建行,等.电视胸腔镜下胸腺切除术治疗重症肌无力.中国胸心血管外科临床杂志,2005,12(4):297-298.
[9]张青平,王如文,蒋耀光,等.胸腔镜胸腺扩大切除治疗重症肌无力(附27例报告).中国微创外科杂志,2008,8(5):422-424.
[10]Raica M,Cimpean AM,Ribatti D.Myasthenia gravis and the thymus gland.A historical review.Clin Exp Med,2008,8(2):61-64.
[11]Lacomis D.Myasthenic crisis.Neurocrit Care,2005,3(3):189-194.
[12]Watanabe A,Watanabe T,Obama T,et al.Prognostic factors for myasthenic crisis after transsternal thymectomy in patients with myasthenia gravis.J Thorac Cardiovasc Surg,2004,127(3):868-876.

备注/Memo

备注/Memo:
基金项目：国家自然科学基金资助（30570625）**通讯作者，Email:qyzhag@zzu.edu.cn①（河南省医药科学研究院，郑州450052）
更新日期/Last Update: 2013-07-16