【摘要】：目的隨著診療技術(shù)及多科合作模式的不斷進(jìn)步及完善,重癥肌無力(MG)患者伴發(fā)胸腺瘤的發(fā)現(xiàn)及確診率越來越高,探討重癥肌無力(MG)伴發(fā)胸腺瘤經(jīng)胸腔鏡下胸腺瘤擴(kuò)大切除術(shù)的圍手術(shù)期短期臨床療效及術(shù)后短期藥物治療后的遠(yuǎn)期療效。方法回顧性分析2012.10-2015.10就診治療于山東大學(xué)齊魯醫(yī)院胸外科并接受胸腔鏡下胸腺擴(kuò)大切除術(shù)(Video-Assisted Thoracoscopic Extended Thymectomy,VATET,以下稱為VATET組)治療的MG伴發(fā)胸腺瘤患者50例,用在同期就診治療于山東大學(xué)齊魯醫(yī)院胸外科并接受傳統(tǒng)經(jīng)胸正中縱劈切口手術(shù)(以下稱為傳統(tǒng)開胸組)治療的MG伴發(fā)胸腺瘤患者18例作為對(duì)照,對(duì)兩組的手術(shù)進(jìn)行時(shí)間(包括開關(guān)胸時(shí)間及其過程中進(jìn)行止血時(shí)間)、術(shù)中總出血量(包括開關(guān)胸時(shí)出血量及術(shù)中胸腔內(nèi)操作過程中出血量)、術(shù)后帶管時(shí)間及術(shù)后的住院時(shí)間進(jìn)行對(duì)照,對(duì)其短期療效進(jìn)行對(duì)比。同時(shí)將VATET組的患者按照改良Osserman分型,每型患者分為VATET術(shù)后短期內(nèi)服用抗膽堿酯酶藥物組及VATET術(shù)后短期內(nèi)未服用服用抗膽堿酯酶藥物組,對(duì)其遠(yuǎn)期療效進(jìn)行對(duì)比。結(jié)果68例患者完成隨訪,獲得完整資料。50例患者手術(shù)為胸腔鏡手術(shù),18例患者為傳統(tǒng)正中縱劈胸骨開胸手術(shù),胸腔鏡無術(shù)中轉(zhuǎn)開放手術(shù)、兩組皆無手術(shù)及術(shù)后出現(xiàn)死亡病例,VATET組1例患者術(shù)后出現(xiàn)肌無力危象,及時(shí)機(jī)械通氣,評(píng)估患者各項(xiàng)指證基本恢復(fù)后,于插管7天后脫管,術(shù)后16天出院。VATET組同傳統(tǒng)開胸組在短期療效上相比,兩組間差異有統(tǒng)計(jì)學(xué)意義(P0.05)。VATET術(shù)后短期內(nèi)(患者術(shù)后無明顯肺部感染、大量胸腔積液或肌無力危象時(shí),Osserman Ⅰ型、Ⅱ型術(shù)后5-7天內(nèi),Ⅲ型以上時(shí)間根據(jù)病情相應(yīng)提前,3-7天內(nèi))行抗膽堿酯酶藥物治療后遠(yuǎn)期療效判定,Ⅰ型患者VATET術(shù)后短期內(nèi)服用抗膽堿酯酶藥組,完全緩解1例,藥物緩解2例,改善3例,無變化1例,惡化0例;Ⅰ型患者VATET術(shù)后MG癥狀出現(xiàn)后服用抗膽堿酯酶藥組,完全緩解1例,藥物緩解2例,改善3例,無變化5例,惡化1例。Ⅱ型及以上患者VATET術(shù)后短期內(nèi)服用抗膽堿酯酶藥組,完全緩解1,藥物緩解3例,改善6例,無變化3例,惡化4例;Ⅱ型及以上患者VATET術(shù)后MG癥狀出現(xiàn)后服用抗膽堿酯酶藥組,完全緩解0例,藥物緩解2例,改善2例,無變化6例,惡化4例。VATET術(shù)后短期內(nèi)服用藥物組與術(shù)后出現(xiàn)MG癥狀后服用藥物組相比較,Ⅰ型VATET術(shù)后患者在術(shù)后是否短時(shí)間內(nèi)服用藥物在遠(yuǎn)期療效差異上無統(tǒng)計(jì)學(xué)意義(P0.05),Ⅱ型及以上VATET術(shù)后患者在術(shù)后是否短時(shí)間內(nèi)服用藥物在遠(yuǎn)期療效差異上有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論三孔式胸腔鏡下胸腺擴(kuò)大根治術(shù)對(duì)治療MG合并胸腺瘤安全并且療效明確,同傳統(tǒng)經(jīng)正中縱劈胸骨胸腺擴(kuò)大切除術(shù)相比在短期療效上更有優(yōu)勢(shì),是一種更加微創(chuàng)并且實(shí)用的手術(shù)方法。同時(shí)經(jīng)胸腔鏡下擴(kuò)大切除術(shù)治療的ⅡA型及以上患者術(shù)后短時(shí)間內(nèi)服用抗膽堿酯酶藥物可獲得較好遠(yuǎn)期療效。
[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，

本文編號(hào)：2129392