CAJ | 학술논문

目的：探讨小切口半劈胸骨行胸腺切除术治疗重症肌无力的手术效果和影响因素及52例手术的经验总结。方法52例均采用正中切口小切口半劈胸骨进胸，切除胸腺及前纵隔所有脂肪组织，其中有外侵表现者，则切除受累之胸膜、心包、动脉外膜，并按临床症状分型、镜下病理分型、临床病理分期、是否根治切除分别分类，统计缓解、改善、无变化、恶化的例数，缓解和改善视为有效，无变化和恶化视为无效，以有效和无效例数行X 2检验。结果本组52例病例，总有效率82.7％（43/52），无变化5例，9.7％，恶化4例，5.8％，其中死亡1例。平均手术时间89.3±24.7min (53min-176min )，术中大血管损伤出血0例，全部病例术中失血量<200ml，术后引流量<200ml，纵膈感染0例，切口感染1例（1.92%），术后平均住院日6.7±3.8天。临床症状分型和镜下病理分型对手术效果的影响无显著性差异（P>0.05）,临床病理分期和是否根治切除对手术效果的影响存在显著性差异（P<0.05）。结论临床症状分型对手术疗效有一定影响，Ⅲ型有效率明显降低，但统计学分析对疗效的影响无显著性差异，提示无论临床分型如何，均应手术，原发性胸腺癌不易根治性切除，但就手术切除对重症肌无力症状改善来看，良恶性肿瘤差异不大， Masaoka分期与胸腺瘤并发重症肌无力的预后密切相关，就改善肌无力症状来看，Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期之间也存在显著性差异，以Ⅱ期效果最好。小切口半劈胸骨行胸腺根治切除术,手术时间短,出血量少,恢复快,优于传统正中开胸手术,手术效果可靠,适宜在基层医院推广。
목적：탐토소절구반벽흉골행흉선절제술치료중증기무력적수술효과화영향인소급52례수술적경험총결。방법52례균채용정중절구소절구반벽흉골진흉，절제흉선급전종격소유지방조직，기중유외침표현자，칙절제수루지흉막、심포、동맥외막，병안림상증상분형、경하병리분형、림상병리분기、시부근치절제분별분류，통계완해、개선、무변화、악화적례수，완해화개선시위유효，무변화화악화시위무효，이유효화무효례수행X 2검험。결과본조52례병례，총유효솔82.7％（43/52），무변화5례，9.7％，악화4례，5.8％，기중사망1례。평균수술시간89.3±24.7min (53min-176min )，술중대혈관손상출혈0례，전부병례술중실혈량<200ml，술후인류량<200ml，종격감염0례，절구감염1례（1.92%），술후평균주원일6.7±3.8천。림상증상분형화경하병리분형대수술효과적영향무현저성차이（P>0.05）,림상병리분기화시부근치절제대수술효과적영향존재현저성차이（P<0.05）。결론림상증상분형대수술료효유일정영향，Ⅲ형유효솔명현강저，단통계학분석대료효적영향무현저성차이，제시무론림상분형여하，균응수술，원발성흉선암불역근치성절제，단취수술절제대중증기무력증상개선래간，량악성종류차이불대， Masaoka분기여흉선류병발중증기무력적예후밀절상관，취개선기무력증상래간，Ⅰ기、Ⅱ기、Ⅲ기화Ⅳ기지간야존재현저성차이，이Ⅱ기효과최호。소절구반벽흉골행흉선근치절제술,수술시간단,출혈량소,회복쾌,우우전통정중개흉수술,수술효과가고,괄의재기층의원추엄。
Objective: Explore smal cut half-cut line sternum thymus gland excision treatment and myasthenia gravis the surgical results and impact factors and 52 cases of surgery experience..Methods: 52 cases are made of a smal incision into the chest incision half sternotomy, removal of the thymus and al anterior mediastinal fat tissue, which has foreign invasion performers, the removal of the pleura, pericardium, arterial involvement of the outer membrane, and then typing of clinical symptoms, mirror under pathological type, clinical staging, whether radical resection were classified statistics remission, improvement, no change in the number of cases of deterioration, al eviate and improve as valid, no change and deterioration deemed invalid to valid and invalid cases the number of rows X2 test.Results:The group of 52 cases, the total efficiency of 82.7% (43/52), unchanged in 5 cases, 9.7%, deterioration of four cases, 5.8%, of which 1 died. The mean operative time 89.3 ± 24.7min (53min-176min), intraoperative bleeding 0 cases of vascular injury, al cases of intraoperative blood loss<200ml, postoperative drainage <200ml, 0 mediastinal infection, wound infection in 1 case (1.92 %), mean postoperative hospital stay 6.7 ± 3.8 days. There was no significant difference (P> 0.05) affect the clinical symptoms and microscopic pathology typing typing on the effect of surgery, there is a significant difference (P <0.05) clinical staging and radical surgical resection influence the effect.Conclusion: The clinical symptoms of type has some influence on the surgery, Ⅲ type efficiency decreased, but no statistical y significant difference in the impact analysis of the efficacy, suggesting regardless of clinical type, should be surgery, primary breast cancer is not easy to radical resection, but on surgical resection of myasthenia gravis symptoms, the differences between benign and malignant smal , Masaoka staging and prognosis of thymoma complicated by myasthenia gravis, between ⅰ, Ⅱ period, Ⅲ and Ⅳalso There were significant differences in order ⅱ best. Semi-sternotomy incision line thymus radical resection, shorter operative time, less blood loss, faster recovery, better than the traditional median sternotomy surgery, surgical results and reliable, suitable for primary hospitals.