中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2011年
11期
17-20
,共4页
张旭%王宇%李默%岳世昌%刘长宏
張旭%王宇%李默%嶽世昌%劉長宏
장욱%왕우%리묵%악세창%류장굉
重症肌无力%胸腔镜%外科手术%横断胸骨%胸骨部分劈开
重癥肌無力%胸腔鏡%外科手術%橫斷胸骨%胸骨部分劈開
중증기무력%흉강경%외과수술%횡단흉골%흉골부분벽개
Myasthenia gravis%Thoracoscopes%Surgical procedures,operative%Median sternotomy%Trans-stemal
目的 比较三种小切口行胸腺切除治疗重症肌无力的手术效果,合理选择手术方式.方法 回顾性分析行胸腺切除术治疗109例重症肌无力患者的临床资料,根据手术切口方式的不同分为胸骨部分劈开组、横断胸骨组和胸腔镜组,比较三组的手术时间、术中出血量、术后胸腔引流量及时间、术后住院时间、术后肺部感染及切口感染、术后肌无力危象、术后慢性疼痛上肢运动障碍和疗效.结果 胸腔镜组术中出血量[(77.5±18.0)ml]、术后胸腔引流量[(100.8±11.8)ml]、术后胸腔引流时间[(2.3±0.5)d]、术后切口感染率(0)优于横断胸骨组[分别为(97.4±14.3)ml、(175.8±18.3)ml、(3.1±0.7)d、6.2%(2/32)]及胸骨部分劈开组[分别为(130.1±24.0)ml、(379.0±45.6)ml、(4.2±0.6)d、13.8%(9/65)](P＜0.05),同时横断胸骨组又优于胸骨部分劈开组(P＜0.05);胸腔镜组术后肺部感染、术后肌无力危象、术后慢性疼痛上肢运动障碍的发生率及术后住院时间均优于横断胸骨组及胸骨部分劈开组(P＜0.05).结论 三种小切口手术方式安全可行,疗效显著,胸腔镜切口手术有着显著的优越性,值得在各大中型医院广泛推广;而对于技术设备不发达的基层医院,横断胸骨切口为更好的选择.
目的 比較三種小切口行胸腺切除治療重癥肌無力的手術效果,閤理選擇手術方式.方法 迴顧性分析行胸腺切除術治療109例重癥肌無力患者的臨床資料,根據手術切口方式的不同分為胸骨部分劈開組、橫斷胸骨組和胸腔鏡組,比較三組的手術時間、術中齣血量、術後胸腔引流量及時間、術後住院時間、術後肺部感染及切口感染、術後肌無力危象、術後慢性疼痛上肢運動障礙和療效.結果 胸腔鏡組術中齣血量[(77.5±18.0)ml]、術後胸腔引流量[(100.8±11.8)ml]、術後胸腔引流時間[(2.3±0.5)d]、術後切口感染率(0)優于橫斷胸骨組[分彆為(97.4±14.3)ml、(175.8±18.3)ml、(3.1±0.7)d、6.2%(2/32)]及胸骨部分劈開組[分彆為(130.1±24.0)ml、(379.0±45.6)ml、(4.2±0.6)d、13.8%(9/65)](P＜0.05),同時橫斷胸骨組又優于胸骨部分劈開組(P＜0.05);胸腔鏡組術後肺部感染、術後肌無力危象、術後慢性疼痛上肢運動障礙的髮生率及術後住院時間均優于橫斷胸骨組及胸骨部分劈開組(P＜0.05).結論 三種小切口手術方式安全可行,療效顯著,胸腔鏡切口手術有著顯著的優越性,值得在各大中型醫院廣汎推廣;而對于技術設備不髮達的基層醫院,橫斷胸骨切口為更好的選擇.
목적 비교삼충소절구행흉선절제치료중증기무력적수술효과,합리선택수술방식.방법 회고성분석행흉선절제술치료109례중증기무력환자적림상자료,근거수술절구방식적불동분위흉골부분벽개조、횡단흉골조화흉강경조,비교삼조적수술시간、술중출혈량、술후흉강인류량급시간、술후주원시간、술후폐부감염급절구감염、술후기무력위상、술후만성동통상지운동장애화료효.결과 흉강경조술중출혈량[(77.5±18.0)ml]、술후흉강인류량[(100.8±11.8)ml]、술후흉강인류시간[(2.3±0.5)d]、술후절구감염솔(0)우우횡단흉골조[분별위(97.4±14.3)ml、(175.8±18.3)ml、(3.1±0.7)d、6.2%(2/32)]급흉골부분벽개조[분별위(130.1±24.0)ml、(379.0±45.6)ml、(4.2±0.6)d、13.8%(9/65)](P＜0.05),동시횡단흉골조우우우흉골부분벽개조(P＜0.05);흉강경조술후폐부감염、술후기무력위상、술후만성동통상지운동장애적발생솔급술후주원시간균우우횡단흉골조급흉골부분벽개조(P＜0.05).결론 삼충소절구수술방식안전가행,료효현저,흉강경절구수술유착현저적우월성,치득재각대중형의원엄범추엄;이대우기술설비불발체적기층의원,횡단흉골절구위경호적선택.
Objective To investigate the best operative approach in the treatment of myasthenia gravis (MG) by comparing surgical effects of median sternotomy, trans-sternal surgery and video-assisted thoracoscope surgery (VATS). Methods One hundred and nine patients who received thymectomy for MG were divided into median sternotomy group,trans-sternal group and VATS group according to the way of operative incision. The clinical features, such as operative time, operative blood loss, postoperative drainage volume and drainage time, postoperative hospitalization time, postoperative pulmonary infection, incisional infection, MG crisis, postoperative chronic pain and upper limb's movement disorder were retrospectively analyzed to evaluate the effect of the surgery. Results The operative blood loss, postoperative drainage volume and drainage time,and incisional infection in VATS group [(77.5 ± 18.0) ml, ( 100.8 ± 11.8) ml,( 2.3 ± 0.5 ) d, 0 ] were superior to those in trans-sternal group[ (97.4 ± 14.3 ) ml, ( 175.8 ± 18.3 ) ml, ( 3.1 ±0.7 ) d, 6.2% ( 2/32 ) ] and median stemotomy group [ ( 130.1 ± 24.0) ml, ( 379.0 ± 45.6 ) ml, (4.2 ± 0.6) d,13.8% (9/65)] (P ＜0.05),and median sternotomy group was the worst. The incidence of postoperative pulmonary infection, MG crisis, upper limb's movement disorder and postoperative hospitalization time in VATS group were superior to those in trans-sternal group and median sternotomy group (P ＜0.05).Conclusions Three mini-incision surgical approaches are safe, feasible and effective. VATS is more advantageous and is worth popularizing in large and medium-sized hospitals. Trans-sternal surgery is the better choice for primary hospitals without advanced technology and equipments.
