胸腔镜与传统胸骨正中劈开治疗胸腺瘤合并重症肌无力的临床疗效分析

发布时间：2018-04-24 19:34

本文选题：胸腔镜 + 传统胸骨正中劈开　；参考：《吉林大学》2014年硕士论文

【摘要】：目的对比电视胸腔镜手术（VATS）与胸骨正中切口胸腺扩大切除治疗胸腺肿瘤合并重症肌无力的临床效果，，以选择合理手术方式，探讨胸腔镜胸腺扩大切除术的临床应用价值。方法回顾性分析我科2008年6月至2013年11月行胸腺扩大切除术治疗190例重症肌无力患者的临床资料，根据不同的手术方式将其分为VATS组（2012年3月至2013年11月，80例）和正中切口开胸组（2008年6月至2013年7月，110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、危象持续时间（肌无力危象时机械通气时间）等指标，采用X2检验分析术后肌无力危象发生率，两组患者均切除胸腺和清扫前纵膈脂肪组织。结果VATS组患者手术术中出血较胸骨正中劈开组明显减少（53.24±11.69ml和97.37士24.61ml，P0.05）；VATS组术后肌无力危象发生率为5.0%（4／80），正中切口开胸组为13．64%（15／110），两组间比较差异有统计学意义（P0.05）。VATS组术后发生危象所需机械通气时间较正中切口开胸组明显缩短（75.33±39.31h和189.20±89.74h，P0.05）；VATS组无围术期肌无力危象发生，胸骨劈开组中8例发生围术期肌无力危象，两组患者均无围手术期死亡。VATS组术中出血量、术后胸腔引流时间、术后住院时间、ICU监护时间均较开胸组减少，两组比较差异有统计学意义（P0.05）；两组手术时间比较差异无显著性（P0.05）。结论VATS胸腺扩大切除术治疗重症肌无力安全性好，术中出血少，手术创伤小，能减少术后肌无力危象的发生，缩短术后肌无力危象所需的机械通气时间，有良好的应用前景。
[Abstract]:Objective to compare the clinical effects of video-assisted thoracoscopic surgery (VATS) and sternal median incision thymectomy in the treatment of thymic neoplasms with myasthenia gravis (MG), and to explore the clinical value of thoracoscopic thymectomy in the treatment of thymic neoplasms with myasthenia gravis. Methods the clinical data of 190 patients with myasthenia gravis treated by extended thymectomy from June 2008 to November 2013 were retrospectively analyzed. The patients were divided into VATS group (n = 80) and median incision group (n = 110 from June 2008 to July 2013) according to different surgical methods. Independent t-test was used to analyze the operation time, intraoperative blood loss, postoperative drainage, crisis duration (mechanical ventilation time of myasthenia crisis), and the incidence of postoperative myasthenia crisis was analyzed by X2 test. Thymus was excised and mediastinal adipose tissue was dissected in both groups. Results the incidence of postoperative myasthenia crisis in the VATS group was significantly lower than that in the median sternotomy group (53.24 卤11.69ml and 97.37 + 24.61ml / P 0.05 vs vats). The incidence of postoperative myasthenia crisis in the VATS group was 5.0 / 80, and 13.64 / 110 in the median incision thoracotomy group. The difference between the two groups was statistically significant (P 0.05). Vats had a significant difference between the two groups in the incidence of postoperative myasthenia crisis. The time required for mechanical ventilation in the crisis group was significantly shorter than that in the median incision thoracotomy group (75.33 卤39.31 h and 189.20 卤89.74 h). There was no perioperative myasthenia crisis in the Vats group. In the split sternotomy group, 8 cases had perioperative myasthenia crisis. No perioperative death. Vats group had less intraoperative blood loss, postoperative thoracic drainage time, postoperative hospitalization time and ICU monitoring time than those in the open chest group. The difference between the two groups was statistically significant (P 0.05), but there was no significant difference in the operation time between the two groups (P 0.05). Conclusion VATS thymectomy for myasthenia gravis is safe, less bleeding and less trauma. It can reduce the incidence of postoperative myasthenia crisis and shorten the time of mechanical ventilation for postoperative myasthenia crisis.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R736.3;R746.1

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