胸腔镜胸腺切除术治疗重症肌无力的临床疗效研究

发布时间：2019-01-24 12:02

【摘要】：目的探讨胸腔镜下胸腺切除术对重症肌无力(myasthenia gravis, MG)的治疗效果,总结胸腔镜下胸腺切除术治疗MG的临床经验。方法收集作者所在医院胸外科2009年10月至2014年9月接受胸腺切除术治疗(包括正中开胸和胸腔镜手术)的38例MG患者的病例资料,并联系患者做术后疗效随访。根据手术方式不同分两组,观察组(N=15)胸腔镜下胸腺切除,对照组(N=23)胸骨正中切口胸腺切除；比较两组的手术时间、术中出血量、术后胸管留置时间、镇痛药的使用、术后重症肌无力危象、术后住院时间、术后疗效等方面的差异。结果两组均无住院期间死亡病例。观察组(胸腔镜胸腺切除术)手术时间(119.53±11.42min)、术中出血量(79±18.15ml)、术后胸管留置时间(2.93±0.46d)、镇痛药物使用(3例)、术后发生肌无力危象(1例)、术后住院时间(7.4±2.09d)；对照组(胸骨正中切口胸腺切除术)手术时间(96.52±6.65min)、术中出血量(215.65±41.87ml)、术后胸管留置时间(3.53±0.59d)、镇痛药物使用(19例)、术后发生肌无力危象(2例)、住院时间(9.57±1.83d)。两组比较在手术时间、术中出血量、术后胸管留置时间、镇痛药的使用、术后住院时间方面的差异有统计学意义(P0.05),术后发生重症肌无力危象的差异无统计学意义。随访显示术后缓解率分别为86.67%、82.61%,无明显统计学差异。结论胸腔镜胸腺切除对于重症肌无力患者,手术安全、微创、美观,术后并发症少、恢复快,其治效果至少可与开胸手术相当,药物治疗效果不佳或合并胸腺增生、胸腺瘤的重症肌无力患者,胸腔镜胸腺切除术可以作为首选的治疗方案。
[Abstract]:Objective to evaluate the efficacy of thoracoscopic thymectomy in the treatment of myasthenia gravis (myasthenia gravis, MG) and to summarize the clinical experience of thoracoscopic thymectomy in the treatment of MG. Methods from October 2009 to September 2014, 38 patients with MG underwent thymectomy (median thoracotomy and thoracoscopic surgery) in our hospital. According to the different operation methods, the patients were divided into two groups: the observation group (N15) underwent thoracoscopic thymectomy, and the control group (N23) underwent thymectomy through the median sternal incision. The difference of operation time, intraoperative bleeding volume, postoperative chest tube indwelling time, use of analgesics, postoperative myasthenia gravis crisis, postoperative hospitalization time and postoperative curative effect were compared between the two groups. Results there were no cases of death during hospitalization in both groups. In the observation group, the operative time (119.53 卤11.42min), intraoperative blood loss (79 卤18.15ml), postoperative chest tube indwelling time (2.93 卤0.46 d), analgesic drug use (3 cases) and myasthenia crisis (1 case) were observed. Postoperative hospitalization time (7.4 卤2.09 days); In the control group (median sternal incision thymectomy), the operative time was 96.52 卤6.65min, the intraoperative bleeding was (215.65 卤41.87ml), the postoperative chest tube retention time was (3.53 卤0.59 days), the analgesic drug was used in 19 cases. Postoperative myasthenia crisis occurred (2 cases), hospitalization time (9.57 卤1.83 d). There were significant differences between the two groups in the operation time, intraoperative bleeding volume, postoperative chest tube retention time, analgesic use, postoperative hospitalization time (P0.05), postoperative myasthenia gravis crisis difference was not statistically significant. The postoperative remission rates were 86.67 and 82.61, respectively, with no significant difference. Conclusion the thoracoscopic thymectomy is safe, minimally invasive and beautiful in patients with myasthenia gravis, with fewer complications and faster recovery. The effect of thoracoscopic thymectomy is at least as good as that of thoracotomy, and the effect of drug therapy is not good or combined with thymus hyperplasia. In patients with thymoma myasthenia gravis, thoracoscopic thymectomy is the first choice of treatment.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R746.1

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