胸腔镜下胸腺扩大切除术治疗重症肌无力的临床研究
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摘要
目的:回顾性比较胸腔镜手术入路(VATS组)和胸骨正中入路(TS组)行胸腺扩大切除术治疗重症肌无力(MG)的短期及长期治疗效果,探讨VATS行胸腺扩大切除术治疗重症肌无力的临床价值。方法:共入组83例患者,其中VATS组50例、TS组33例;比较两组患者在手术时间、术中出血量、24h胸腔引流量、胸管留置时间、术后住院时间、术后并发症、术后肌无力危象和完全缓解率(CSR)等方面的异同。结果:VATS组手术时间(110.8±38.06)min、术中出血量(68.5±16.22)ml、24h引流量(110.0±35.50)ml、胸管留置时间(3.6±1.25)d、术后住院天数(9.8±1.85)d等优于TS组的(199.0±36.05)min、(205.8±34.55)ml、(326.3±56.22)ml、(5.6±1.19)d、(16.1±13.3)d;VATS组肺部感染率(7.5%)低于TS组(25.8%);VATS组2例发生术后肌无力危象,TS组有5例肌无力危象。平均随访57.5个月,VATS组完全缓解率为51%,TS组为52.9%,两组比较差异无统计学意义(P=0.654)。结论:VATS行胸腺扩大切除术治疗重症肌无力具有较好的长期有效率,而且具有术后肌无力危象发生率低、手术并发症少、术后出血少、住院时间短等优点,是安全有效的选择。
Objective:The purpose of this study was to compare perioperative outcomes in patients who underwent video-assisted thoracoscopic surgery(VATS group)or transsternal thymectomy surgery(TS group)and assess the VATS treatment for the myasthenia gravis.Methods:A total of 83 patients were enrolled,including 50 cases in VATS group and 33 cases in TS group;the two groups were compared in duration of surgery,amount of blood loss,thoracic drainage volume of first-24-hours,duration of chest drainage,duration of postoperative hospital stay,postoperative complications,postoperative crisis,CSR and effect etc.Results:There were significantly difference in duration of surgery[VATS group(110.8±38.06)min VS TS group(199.0±36.05)min],the intraoperative blood loss[VATS group(68.5±16.22)ml VS TS group(205.8±34.55)ml],the thoracic drainage volume of first-24-hours[VATS group(110.0±35.50)ml VS TS group(326.3±56.22)ml],the duration of chest drainages[VATS group(3.6±1.25)d VS TS group(5.6±1.19)d],the postoperative hospital stay[VATS group(9.8±1.85)d VS TS group(16.1±13.3)d],The rate of pneumonia[VATS group 7.5% VS TS group 25.8%].However,there was no significantly difference between the CSR[VATS group 51% VS TS group 52.9%].Conclusion:VATS treatment for the myasthenia gravis is technically feasible and safe and is less invasive than TS thymectomy.
Objective:The purpose of this study was to compare perioperative outcomes in patients who underwent video-assisted thoracoscopic surgery(VATS group)or transsternal thymectomy surgery(TS group)and assess the VATS treatment for the myasthenia gravis.Methods:A total of 83 patients were enrolled,including 50 cases in VATS group and 33 cases in TS group;the two groups were compared in duration of surgery,amount of blood loss,thoracic drainage volume of first-24-hours,duration of chest drainage,duration of postoperative hospital stay,postoperative complications,postoperative crisis,CSR and effect etc.Results:There were significantly difference in duration of surgery[VATS group(110.8±38.06)min VS TS group(199.0±36.05)min],the intraoperative blood loss[VATS group(68.5±16.22)ml VS TS group(205.8±34.55)ml],the thoracic drainage volume of first-24-hours[VATS group(110.0±35.50)ml VS TS group(326.3±56.22)ml],the duration of chest drainages[VATS group(3.6±1.25)d VS TS group(5.6±1.19)d],the postoperative hospital stay[VATS group(9.8±1.85)d VS TS group(16.1±13.3)d],The rate of pneumonia[VATS group 7.5% VS TS group 25.8%].However,there was no significantly difference between the CSR[VATS group 51% VS TS group 52.9%].Conclusion:VATS treatment for the myasthenia gravis is technically feasible and safe and is less invasive than TS thymectomy.
引文
[1]Jaretzki A,Barohn RJ,Ernstoff RM,et al.Myasthenia gravis:Recommendations for clinical research standards(Reprinted from Neurology,vol 55,pg 16-23,2000)〔J〕.Annals of Thoracic Surgery,2000,70(1):327-334.
[2]Liu CW,Luo M,Mei JD,et al.Perioperative and long-term outcome of thymectomy for myasthenia gravis:comparison of surgical approaches and prognostic analysis〔J〕.Chinese Medical Journal,2013,126(1):34-40.
[3]Toolabi K,Aminian A,Javid MJ,et al.Mid-term results of thoracoscopic thymectomy for myasthenia gravis〔J〕.Neurology India,2009,57(4):402-405.
[4]Ruckert JC,Walter M,Muller JM.Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis〔J〕.The Annals of Thoracic Surgery,2000,70(5):1656-1661.
[5]Chen Z,Zuo J,Zou J,et al.Cellular immunity following videoassisted thoracoscopic and open resection for non-thymomatous myasthenia gravis〔J〕.European journal of cardio-thoracic surgery:official journal of the European Association for Cardiothoracic Surgery,2014,45(4):646-651.
[6]Endo S,Hasegawa T,Sato Y,et al.Inhibition of IL-6overproduction by steroid treatment before transsternal thymectomy for myasthenia gravis:does it help stabilize perioperative condition?〔J〕.European Journal of Neurology,2005,12(10):768-773.
[7]Werneck LC,Scola RH,Germiniani FM,et al.Myasthenic crisis:report of 24cases〔J〕.Arquivos Neuro psiquiatria,2002,60(3-A):519-526.
[8]Huang CS,Cheng CY,Hsu HS,et al.Video-assisted thoracoscopic surgery versus sternotomy in treating myasthenia gravis:comparison by a case-matched study〔J〕.Surgery Today,2011,41(3):338-345.
[9]Lo CM,Lu HI,Hsieh MJ,et al.Thymectomy for myasthenia gravis:video-assisted versus transsternal〔J〕.Journal of the Formosan Medical Association,2014,113(10):722-726.
[10]强光亮.胸腔镜与胸骨劈开胸腺切除术治疗重症肌无力荟萃分析〔J〕.中华胸心血管外科杂志,2015,31(4):221-229.
[2]Liu CW,Luo M,Mei JD,et al.Perioperative and long-term outcome of thymectomy for myasthenia gravis:comparison of surgical approaches and prognostic analysis〔J〕.Chinese Medical Journal,2013,126(1):34-40.
[3]Toolabi K,Aminian A,Javid MJ,et al.Mid-term results of thoracoscopic thymectomy for myasthenia gravis〔J〕.Neurology India,2009,57(4):402-405.
[4]Ruckert JC,Walter M,Muller JM.Pulmonary function after thoracoscopic thymectomy versus median sternotomy for myasthenia gravis〔J〕.The Annals of Thoracic Surgery,2000,70(5):1656-1661.
[5]Chen Z,Zuo J,Zou J,et al.Cellular immunity following videoassisted thoracoscopic and open resection for non-thymomatous myasthenia gravis〔J〕.European journal of cardio-thoracic surgery:official journal of the European Association for Cardiothoracic Surgery,2014,45(4):646-651.
[6]Endo S,Hasegawa T,Sato Y,et al.Inhibition of IL-6overproduction by steroid treatment before transsternal thymectomy for myasthenia gravis:does it help stabilize perioperative condition?〔J〕.European Journal of Neurology,2005,12(10):768-773.
[7]Werneck LC,Scola RH,Germiniani FM,et al.Myasthenic crisis:report of 24cases〔J〕.Arquivos Neuro psiquiatria,2002,60(3-A):519-526.
[8]Huang CS,Cheng CY,Hsu HS,et al.Video-assisted thoracoscopic surgery versus sternotomy in treating myasthenia gravis:comparison by a case-matched study〔J〕.Surgery Today,2011,41(3):338-345.
[9]Lo CM,Lu HI,Hsieh MJ,et al.Thymectomy for myasthenia gravis:video-assisted versus transsternal〔J〕.Journal of the Formosan Medical Association,2014,113(10):722-726.
[10]强光亮.胸腔镜与胸骨劈开胸腺切除术治疗重症肌无力荟萃分析〔J〕.中华胸心血管外科杂志,2015,31(4):221-229.