三孔式胸腔镜下胸腺扩大切除术治疗MG伴发胸腺瘤的临床病例分析
发布时间：2018-07-17 06:26
【摘要】：目的随着诊疗技术及多科合作模式的不断进步及完善,重症肌无力(MG)患者伴发胸腺瘤的发现及确诊率越来越高,探讨重症肌无力(MG)伴发胸腺瘤经胸腔镜下胸腺瘤扩大切除术的围手术期短期临床疗效及术后短期药物治疗后的远期疗效。方法回顾性分析2012.10-2015.10就诊治疗于山东大学齐鲁医院胸外科并接受胸腔镜下胸腺扩大切除术(Video-Assisted Thoracoscopic Extended Thymectomy,VATET,以下称为VATET组)治疗的MG伴发胸腺瘤患者50例,用在同期就诊治疗于山东大学齐鲁医院胸外科并接受传统经胸正中纵劈切口手术(以下称为传统开胸组)治疗的MG伴发胸腺瘤患者18例作为对照,对两组的手术进行时间(包括开关胸时间及其过程中进行止血时间)、术中总出血量(包括开关胸时出血量及术中胸腔内操作过程中出血量)、术后带管时间及术后的住院时间进行对照,对其短期疗效进行对比。同时将VATET组的患者按照改良Osserman分型,每型患者分为VATET术后短期内服用抗胆碱酯酶药物组及VATET术后短期内未服用服用抗胆碱酯酶药物组,对其远期疗效进行对比。结果68例患者完成随访,获得完整资料。50例患者手术为胸腔镜手术,18例患者为传统正中纵劈胸骨开胸手术,胸腔镜无术中转开放手术、两组皆无手术及术后出现死亡病例,VATET组1例患者术后出现肌无力危象,及时机械通气,评估患者各项指证基本恢复后,于插管7天后脱管,术后16天出院。VATET组同传统开胸组在短期疗效上相比,两组间差异有统计学意义(P0.05)。VATET术后短期内(患者术后无明显肺部感染、大量胸腔积液或肌无力危象时,Osserman Ⅰ型、Ⅱ型术后5-7天内,Ⅲ型以上时间根据病情相应提前,3-7天内)行抗胆碱酯酶药物治疗后远期疗效判定,Ⅰ型患者VATET术后短期内服用抗胆碱酯酶药组,完全缓解1例,药物缓解2例,改善3例,无变化1例,恶化0例;Ⅰ型患者VATET术后MG症状出现后服用抗胆碱酯酶药组,完全缓解1例,药物缓解2例,改善3例,无变化5例,恶化1例。Ⅱ型及以上患者VATET术后短期内服用抗胆碱酯酶药组,完全缓解1,药物缓解3例,改善6例,无变化3例,恶化4例;Ⅱ型及以上患者VATET术后MG症状出现后服用抗胆碱酯酶药组,完全缓解0例,药物缓解2例,改善2例,无变化6例,恶化4例。VATET术后短期内服用药物组与术后出现MG症状后服用药物组相比较,Ⅰ型VATET术后患者在术后是否短时间内服用药物在远期疗效差异上无统计学意义(P0.05),Ⅱ型及以上VATET术后患者在术后是否短时间内服用药物在远期疗效差异上有统计学意义(P0.05)。结论三孔式胸腔镜下胸腺扩大根治术对治疗MG合并胸腺瘤安全并且疗效明确,同传统经正中纵劈胸骨胸腺扩大切除术相比在短期疗效上更有优势,是一种更加微创并且实用的手术方法。同时经胸腔镜下扩大切除术治疗的ⅡA型及以上患者术后短时间内服用抗胆碱酯酶药物可获得较好远期疗效。
[Abstract]:Objective with the improvement of diagnosis and treatment technology and multi-disciplinary cooperation model, the detection and diagnosis rate of thymoma associated with myasthenia gravis (MG) is increasing. To investigate the perioperative clinical effect of myasthenia gravis (MG) combined with thymoma extended resection under thoracoscope and the long-term effect after short-term drug therapy. Methods A retrospective analysis was made on 50 patients with MG complicated with thymoma treated in Qilu Hospital, Shandong University, from October 10 to October, 2012.These patients were treated with Video-Assisted Thoracoscopic extended thymectomy (VATET group). Eighteen patients with thymoma associated with MG were treated at Qilu Hospital of Shandong University at the same time and treated with traditional transthoracic median longitudinal incision (hereinafter referred to as the traditional thoracotomy group) as control. Time of operation (including time of chest switch and hemostasis during operation), total intraoperative bleeding (including volume of bleeding during chest switching and intrapleural operation), time of tubing and postoperative bleeding during operation in both groups The length of stay in the hospital was compared, The short-term curative effect was compared. According to the modified Osserman classification, the patients in the VATET group were divided into two groups: the patients who took anticholinesterase drugs in the short term after VATET and the patients who did not take the anticholinesterase drugs in the short term after VATET. The long-term effects were compared. Results Sixty-eight patients were followed up and 50 patients underwent thoracoscopic surgery. 18 patients underwent thoracoscopic thoracotomy and 18 patients underwent thoracoscopic surgery. One patient in the VATET group had postoperative myasthenia crisis, mechanical ventilation in time, and evaluation of the patients' indications after the basic recovery, after 7 days of intubation, after intubation, one patient in the VATET group developed myasthenia crisis, and the patients in the VATET group had no operative or postoperative death cases. 16 days after operation, there was a significant difference between the two groups in the short-term curative effect between the two groups compared with the traditional open chest group (P0.05) .VATET had no obvious pulmonary infection after operation, and Osserman 鈪，
本文编号：2129392
[Abstract]:Objective with the improvement of diagnosis and treatment technology and multi-disciplinary cooperation model, the detection and diagnosis rate of thymoma associated with myasthenia gravis (MG) is increasing. To investigate the perioperative clinical effect of myasthenia gravis (MG) combined with thymoma extended resection under thoracoscope and the long-term effect after short-term drug therapy. Methods A retrospective analysis was made on 50 patients with MG complicated with thymoma treated in Qilu Hospital, Shandong University, from October 10 to October, 2012.These patients were treated with Video-Assisted Thoracoscopic extended thymectomy (VATET group). Eighteen patients with thymoma associated with MG were treated at Qilu Hospital of Shandong University at the same time and treated with traditional transthoracic median longitudinal incision (hereinafter referred to as the traditional thoracotomy group) as control. Time of operation (including time of chest switch and hemostasis during operation), total intraoperative bleeding (including volume of bleeding during chest switching and intrapleural operation), time of tubing and postoperative bleeding during operation in both groups The length of stay in the hospital was compared, The short-term curative effect was compared. According to the modified Osserman classification, the patients in the VATET group were divided into two groups: the patients who took anticholinesterase drugs in the short term after VATET and the patients who did not take the anticholinesterase drugs in the short term after VATET. The long-term effects were compared. Results Sixty-eight patients were followed up and 50 patients underwent thoracoscopic surgery. 18 patients underwent thoracoscopic thoracotomy and 18 patients underwent thoracoscopic surgery. One patient in the VATET group had postoperative myasthenia crisis, mechanical ventilation in time, and evaluation of the patients' indications after the basic recovery, after 7 days of intubation, after intubation, one patient in the VATET group developed myasthenia crisis, and the patients in the VATET group had no operative or postoperative death cases. 16 days after operation, there was a significant difference between the two groups in the short-term curative effect between the two groups compared with the traditional open chest group (P0.05) .VATET had no obvious pulmonary infection after operation, and Osserman 鈪，
本文编号：2129392
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