【摘要】：目的隨著診療技術及多科合作模式的不斷進步及完善,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)胸腔鏡下胸腺瘤擴大切除術的圍手術期短期臨床療效及術后短期藥物治療后的遠期療效。方法回顧性分析2012.10-2015.10就診治療于山東大學齊魯醫(yī)院胸外科并接受胸腔鏡下胸腺擴大切除術(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(以下稱為傳統(tǒng)開胸組)治療的MG伴發(fā)胸腺瘤患者18例作為對照,對兩組的手術進行時間(包括開關胸時間及其過程中進行止血時間)、術中總出血量(包括開關胸時出血量及術中胸腔內操作過程中出血量)、術后帶管時間及術后的住院時間進行對照,對其短期療效進行對比。同時將VATET組的患者按照改良Osserman分型,每型患者分為VATET術后短期內服用抗膽堿酯酶藥物組及VATET術后短期內未服用服用抗膽堿酯酶藥物組,對其遠期療效進行對比。結果68例患者完成隨訪,獲得完整資料。50例患者手術為胸腔鏡手術,18例患者為傳統(tǒng)正中縱劈胸骨開胸手術,胸腔鏡無術中轉開放手術、兩組皆無手術及術后出現(xiàn)死亡病例,VATET組1例患者術后出現(xiàn)肌無力危象,及時機械通氣,評估患者各項指證基本恢復后,于插管7天后脫管,術后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)計學意義(P0.05)。VATET術后短期內(患者術后無明顯肺部感染、大量胸腔積液或肌無力危象時,Osserman Ⅰ型、Ⅱ型術后5-7天內,Ⅲ型以上時間根據(jù)病情相應提前,3-7天內)行抗膽堿酯酶藥物治療后遠期療效判定,Ⅰ型患者VATET術后短期內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術后短期內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術后短期內服用藥物組與術后出現(xiàn)MG癥狀后服用藥物組相比較,Ⅰ型VATET術后患者在術后是否短時間內服用藥物在遠期療效差異上無統(tǒng)計學意義(P0.05),Ⅱ型及以上VATET術后患者在術后是否短時間內服用藥物在遠期療效差異上有統(tǒng)計學意義(P0.05)。結論三孔式胸腔鏡下胸腺擴大根治術對治療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大切除術相比在短期療效上更有優(yōu)勢,是一種更加微創(chuàng)并且實用的手術方法。同時經(jīng)胸腔鏡下擴大切除術治療的ⅡA型及以上患者術后短時間內服用抗膽堿酯酶藥物可獲得較好遠期療效。
[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，

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