本文選題：胸腔鏡 + 傳統(tǒng)胸骨正中劈開��； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的對比電視胸腔鏡手術(shù)（VATS）與胸骨正中切口胸腺擴(kuò)大切除治療胸腺腫瘤合并重癥肌無力的臨床效果，，以選擇合理手術(shù)方式，探討胸腔鏡胸腺擴(kuò)大切除術(shù)的臨床應(yīng)用價值。 方法回顧性分析我科2008年6月至2013年11月行胸腺擴(kuò)大切除術(shù)治療190例重癥肌無力患者的臨床資料，根據(jù)不同的手術(shù)方式將其分為VATS組（2012年3月至2013年11月，80例）和正中切口開胸組（2008年6月至2013年7月，110例）。采用獨(dú)立樣本t檢驗(yàn)分析手術(shù)時間、術(shù)中出血量、術(shù)后引流量、危象持續(xù)時間（肌無力危象時機(jī)械通氣時間）等指標(biāo)，采用X2檢驗(yàn)分析術(shù)后肌無力危象發(fā)生率，兩組患者均切除胸腺和清掃前縱膈脂肪組織。 結(jié)果VATS組患者手術(shù)術(shù)中出血較胸骨正中劈開組明顯減少（53.24±11.69ml和97.37士24.61ml，P0.05）；VATS組術(shù)后肌無力危象發(fā)生率為5.0%（4／80），正中切口開胸組為13．64%（15／110），兩組間比較差異有統(tǒng)計(jì)學(xué)意義（P0.05）。VATS組術(shù)后發(fā)生危象所需機(jī)械通氣時間較正中切口開胸組明顯縮短（75.33±39.31h和189.20±89.74h，P0.05）；VATS組無圍術(shù)期肌無力危象發(fā)生，胸骨劈開組中8例發(fā)生圍術(shù)期肌無力危象，兩組患者均無圍手術(shù)期死亡。VATS組術(shù)中出血量、術(shù)后胸腔引流時間、術(shù)后住院時間、ICU監(jiān)護(hù)時間均較開胸組減少，兩組比較差異有統(tǒng)計(jì)學(xué)意義（P0.05）；兩組手術(shù)時間比較差異無顯著性（P0.05）。結(jié)論VATS胸腺擴(kuò)大切除術(shù)治療重癥肌無力安全性好，術(shù)中出血少，手術(shù)創(chuàng)傷小，能減少術(shù)后肌無力危象的發(fā)生，縮短術(shù)后肌無力危象所需的機(jī)械通氣時間，有良好的應(yīng)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 鹵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 鹵39.31 h and 189.20 鹵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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R736.3;R746.1

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