[1]邱志宏 陈艰 陈立如 林庆 吴昊孙 黄涛 周鑫 柳阳春*.剑突下与双侧胸入路电视胸腔镜胸腺扩大切除治疗重症肌无力的比较[J].中国微创外科杂志,2020,01(1):26-30.
　Qiu Zhihong,Chen Jian,Chen Liru,et al.A Comparative Study Between Subxiphoid and Bilateral Thoracic Approach Videoassisted Thoracoscopic Surgery Extended Thymectomy for Myasthenia Gravis[J].Chinese Journal of Minimally Invasive Surgery,2020,01(1):26-30.
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剑突下与双侧胸入路电视胸腔镜胸腺扩大切除治疗重症肌无力的比较()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年1期
页码:
26-30
栏目:
临床研究
出版日期:
2020-03-25

文章信息/Info

Title:
A Comparative Study Between Subxiphoid and Bilateral Thoracic Approach Videoassisted Thoracoscopic Surgery Extended Thymectomy for Myasthenia Gravis
作者:
邱志宏 陈艰 陈立如 林庆 吴昊孙 黄涛 周鑫 柳阳春*
（江西省人民医院胸外科，南昌330006）
Author(s):
Qiu Zhihong;  Chen Jian;  Chen Liru;  et al.
Department of Thoracic Surgery, Jiangxi Provincial People’s Hospital, Nanchang 330006, China
关键词:
剑突下入路; 双侧胸入路; 电视胸腔镜; 扩大胸腺切除; 重症肌无力
Keywords:
Subxiphoid approach; Bilateral thoracic approach; Thoracoscope; Extended thymectomy; Myasthenia gravis
文献标志码:
A
摘要:
目的比较剑突下与双侧胸入路电视胸腔镜胸腺扩大切除治疗重症肌无力（myasthenia gravis, MG）的疗效。方法回顾性分析2013年11月~2016年12月我院电视胸腔镜扩大胸腺切除治疗65例MG的临床资料。剑突下入路组44例，单腔气管插管，取“人”字位，两腿分开，剑突下正中做一2 cm直切口，该切口作为胸腔镜孔，左、右肋弓下缘各做一0.5 cm切口，此切口作为操作孔；双侧胸入路组21例，双腔气管插管，左、右各取3个0.5~1.0 cm操作孔。完整切除胸腺及周围脂肪组织。比较2组术中、术后情况及疗效［根据美国重症肌无力基金会（Myasthenia Gravis Foundation of America, MGFA）提出的分类系统评估］。结果2组患者术中出血量、中转开胸率、术后延迟拔管、术后并发症、术后住院时间、胸管引流时间及引流量等差异无显著性（P>0.05）。剑突下入路组手术时间（136.4±27.5）min，明显短于双侧胸入路组（155.0±30.6）min(t=2.461,P=0.017)。剑突下入路组患者术后第1、3、7天疼痛视觉模拟评分（Visual Analogue Scale，VAS）明显低于双侧胸入路组（P<0.05）。围手术期无严重并发症及死亡。失访5例，60例随访16~58个月，平均27个月，1例死亡，2组远期疗效差异无显著性（Z=-0.532, P=0.594）。结论剑突下或双侧胸入路电视胸腔镜胸腺扩大切除治疗MG安全可行，效果相当，其中剑突下入路能很大程度减轻MG患者术后疼痛，缩短手术时间，值得临床推广。
Abstract:
ObjectiveTo compare the effects of extended thymectomy for myasthenia gravis (MG) treated by subxiphoid or bilateral thoracic approach videoassisted thoracoscopic surgery (VATS).MethodsBetween November 2013 and December 2016, 65 operations of thymectomy were performed for treating MG. Resection via subxiphoid approach were carried out in 44 patients. Under singlelumen endotracheal intubation, the patients were placed in the supine position on the operating table with legs open, and the surgeon stood between the patient’s legs and the assistant was on the right side. A 2cm straight incision was made in the middle of the xiphoid process, which was used as a thoracoscope hole. Another two 0.5cm pleural thoracic ports under the bilateral costal arches were created, which were used as operation holes. The bilateral thoracic approach surgery was performed in 21 patients. They underwent doublelumen endotracheal intubation and singlelung ventilation. Three ports 05-1.0 cm in length were made from left and right respectively. The removal of the thymus and surrounding adipose tissues was completed. The intraoperative and postoperative data were compared between the two groups, and clinical outcomes were assessed according to the classification system of Myasthenia Gravis Foundation of America (MGFA).ResultsNo significant differences were found in blood loss during operation, rate of conversion to thoracotomy, postoperative delayed extubation, postoperative complications, postoperative hospital stay, and duration and amount of postoperative chest tube drainage between the two groups (P>0.05). As compared with the bilateral thoracic approach, the operation time of subxiphoid approach procedure was significantly shorter ［(155.0±30.6) min vs. (136.4±27.5) min, t=2.461, P=0.017］. The pain evaluated by visual analogue scale on postoperative day 1, 3, and 7 were significantly higher for bilateral thoracic approach than subxiphoid approach (P<0.05). There were no serious complications and perioperative mortality in the both groups. A total of 60 patients were followed up after thymectomy for a median time of 27 months(range, 16-58 months). There were 5 cases of lost of followups. One patient died during this period. No statistically significant difference was found for longterm curative effects (Z=-0.532, P=0.594).ConclusionsBoth subxiphoid and bilateral thoracic approaches were safe and feasible for the treatment of MG, with comparable effects. The subxiphoid approach greatly reduces the postoperative pain of MG patients and shorten operation time, which is worthy of clinical promotion.

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备注/Memo

备注/Memo:
*通讯作者，Email:lyc195411@sina.com（柳阳春）;xuquan7210@163.com（徐全）徐全*（江西省人民医院胸外科，南昌330006）
更新日期/Last Update: 2020-04-16