CAJ | 학술논문

目的：比较电视胸腔镜手术（ video－assisted thoracoscopic surgery ，VATS）与胸骨劈开扩大胸腺切除治疗重症肌无力的疗效。方法回顾性分析2008年1月～2012年6月扩大胸腺切除治疗重症肌无力70例，其中VATS组43例，其中全麻双腔气管插管30例，单腔气管插管支气管封堵13例，左侧卧30°，右侧3个5～10 mm操作孔，切除双侧膈神经中间的胸腺及脂肪组织；胸骨劈开组胸骨劈开27例，全麻单腔气管插管，仰卧位，正中胸骨劈开，切除胸腺及纵隔脂肪组织。比较2组术中、术后情况及疗效。结果 VATS组术中出血量中位数100 ml（20～600 ml），明显少于胸骨劈开组中位数200 ml（50～2000 ml）（Z＝－3．978，P＝0．000）；VATS组引流管留置时间中位数2 d（0．5～5 d），明显短于胸骨劈开组中位数3 d（1～20 d）（Z＝－4．462，P＝0．000）；VATS组ICU时间中位数1 d（1～15 d），明显短于胸骨劈开组中位数3 d（1～75 d）（Z＝－3．358， P＝0．001）；VATS组术后住院时间中位数12 d（5～100 d）明显短于胸骨劈开组中位数23 d（11～95 d）（Z＝－4．715，P＝0．000）；VATS组住院费用（25897．8±12743．2）元，明显低于胸骨劈开组（45568．8±29413．5）元（ t＝－3．858，P＝0．000）。2组术后随访16～66个月，中位数28个月，术后12个月2组治疗效果无显著性差异（Z＝－0．593，P＝0．553）。结论VATS扩大胸腺切除术可行，较胸骨劈开术具有创伤小、恢复快等优点。
목적：비교전시흉강경수술（ video－assisted thoracoscopic surgery ，VATS）여흉골벽개확대흉선절제치료중증기무력적료효。방법회고성분석2008년1월～2012년6월확대흉선절제치료중증기무력70례，기중VATS조43례，기중전마쌍강기관삽관30례，단강기관삽관지기관봉도13례，좌측와30°，우측3개5～10 mm조작공，절제쌍측격신경중간적흉선급지방조직；흉골벽개조흉골벽개27례，전마단강기관삽관，앙와위，정중흉골벽개，절제흉선급종격지방조직。비교2조술중、술후정황급료효。결과 VATS조술중출혈량중위수100 ml（20～600 ml），명현소우흉골벽개조중위수200 ml（50～2000 ml）（Z＝－3．978，P＝0．000）；VATS조인류관류치시간중위수2 d（0．5～5 d），명현단우흉골벽개조중위수3 d（1～20 d）（Z＝－4．462，P＝0．000）；VATS조ICU시간중위수1 d（1～15 d），명현단우흉골벽개조중위수3 d（1～75 d）（Z＝－3．358， P＝0．001）；VATS조술후주원시간중위수12 d（5～100 d）명현단우흉골벽개조중위수23 d（11～95 d）（Z＝－4．715，P＝0．000）；VATS조주원비용（25897．8±12743．2）원，명현저우흉골벽개조（45568．8±29413．5）원（ t＝－3．858，P＝0．000）。2조술후수방16～66개월，중위수28개월，술후12개월2조치료효과무현저성차이（Z＝－0．593，P＝0．553）。결론VATS확대흉선절제술가행，교흉골벽개술구유창상소、회복쾌등우점。
Objective To compare clinical outcomes of extended thymectomy for myasthenia gravis ( MG ) treated by transsternal approach or video-assisted thoracoscopic surgery ( VATS). Methods Between January 2008 and June 2012, 70 operations of thymectomy were performed for treating MG , either by VATS (43 cases) or by transsternal approach (27 cases).In the VATS group, the surgery was conducted under general anaesthesia with double lumen intubation in 30 cases and with single lumen intubation and bronchial occlusion in 13 cases.The patients were placed in a 30°left-sided recumbent position .Three ports 5-10 mm in diameter were introduced into the right chest cavity .The thymus gland and fatty tissue between the bilateral phrenic nerves were resected.In the transsternal group, patients were operated under general anaesthesia with single lumen intubation in a recumbent position.The sternum was opened medially to resect the thymus gland and fatty tissue .Clinical data were compared between the two groups. Results The blood loss, time for postoperative chest drainage , length of ICU stay, length of hospital stay, and total hospitalization costs in the VATS group were statistically different than those in the transsternal group [100 ml (20-600 ml) vs.200 ml (50-2000 ml), Z=-3.978, P=0.000;2 d (0.5-5 d) vs.3 d (1-20 d), Z=-4.462, P=0.000;1 d (1-15 d) vs.3 d (1-75 d), Z=-3.358, P=0.001;12 d (5-100 d) vs.23 d (11-95 d), Z=-4.715, P=0.000;(25 897.8 ±12 743.2) yuan vs.(45 568.8 ±29 413.5) yuan, t=-3.858, P=0.000].The average follow-up time was 28 months (16-66 months), and no statistically significant difference was found in treatment effects (Z=-0.593, P=0.553). Conclusion Extended thymectomy for MG by VATS is feasible and minimally invasive , which should be popularized .