CAJ | 학술논문

目的：探讨胸腔镜手术治疗胸腺瘤合并再生障碍性贫血（AA）的疗效。方法收集胸腺瘤合并AA 3例，应用胸腔镜行胸腺瘤切除＋胸腺扩大切除术，手术时间60～90 min，术中出血20～50 mL，术后予以预防感染常规处理。通过万方数据库进行文献检索国内近5年报道的胸腺瘤合并AA，选择其中病历资料完整且具有代表性的25例进行文献复习和总结。结果本组3例患者术后2周内血红蛋白均有明显上升；3周后贫血症状复发2例。其中病例1术后1个月再次出现头晕、乏力等贫血症状；病例2术后3周再次出现面色苍白、乏力症状；病例3无贫血症状复发。3例随访至今均无胸腺瘤复发。选择国内25例代表性文献，术后早期AA情况明显改善，按术后随访满1年，且无AA复发征象作为手术有效标准，有效率为36％（9/25例）。结论①胸腺瘤切除术对治疗AA是有效的。②胸腔镜微创手术治疗胸腺瘤合并AA与开胸手术相比其在手术操作及患者术后康复方面优势明显，值得提倡和推广。
목적：탐토흉강경수술치료흉선류합병재생장애성빈혈（AA）적료효。방법수집흉선류합병AA 3례，응용흉강경행흉선류절제＋흉선확대절제술，수술시간60～90 min，술중출혈20～50 mL，술후여이예방감염상규처리。통과만방수거고진행문헌검색국내근5년보도적흉선류합병AA，선택기중병력자료완정차구유대표성적25례진행문헌복습화총결。결과본조3례환자술후2주내혈홍단백균유명현상승；3주후빈혈증상복발2례。기중병례1술후1개월재차출현두훈、핍력등빈혈증상；병례2술후3주재차출현면색창백、핍력증상；병례3무빈혈증상복발。3례수방지금균무흉선류복발。선택국내25례대표성문헌，술후조기AA정황명현개선，안술후수방만1년，차무AA복발정상작위수술유효표준，유효솔위36％（9/25례）。결론①흉선류절제술대치료AA시유효적。②흉강경미창수술치료흉선류합병AA여개흉수술상비기재수술조작급환자술후강복방면우세명현，치득제창화추엄。
Objective To investigate the effect of thoracoscopic operation in the treatment of thymoma with aplastic anemia(AA). Methods Three cases thymoma with AA were collected in Shenzhen Hospital of Peking University.Video-assisted thoracoscopy for thymoma resection plus extended thymectomy was applied,the operation time was 60-90 minutes,the bleeding amount was 20-50mL in the operation, and postoperative routine treatment was performed to prevent infection.Through search of literature of Wanfang database in China in the past 5 years,thymoma associated with AA was reported,and the clinical data and the representative of the 25 cases of literature were reviewed and summarized.Results The Hb was significantly increased after 2 weeks in 3 patients,and anemia symptom recurred after 3 weeks in 2 ca-ses.Case 1 appeared dizziness,fatigue and other symptoms of anemia again 1 month after operation.Case 2 recurred paleness,fatigue 3 weeks after operation.Case 3 had no recurrence.Three cases were followed-up to date and they were without thymomarecurrence.Twenty-five cases of representative literature were chosen in China.Postoperative improvement of early AA,follow-up for at least 1 year,and no AA recurrence being set as effective operation standard,the efficiency was 36%(9/25 cases).Conclusions ①Thymoma resection is effective in the treatment of AA.②Compared with open chest operation,minimally invasive thoracoscopic operation in treatment of thymoma with AA has obvious advantage in operation and postoperative rehabilitation of patients.The advantage of thoracoscopic operation is obvious,so the minimally invasive thoracoscopic operation in the treatment of thymoma with AA is worth advocating and promoting.