"三孔式"经剑突肋缘下胸腺切除治疗重症肌无力

目的评估"三孔式"经剑突肋缘下胸腺切除术应用于重症肌无力治疗的安全性和有效性。 方法该研究纳入2013年12月至2015年7月收治的重症肌无力患者113例,均采用"三孔式"前纵隔剑突下胸腺切除治疗,统计分析手术一般情况(切口长度、手术时间、术中出血量、中转开胸率、胸腺完整切除率、周围脂肪清扫率、术后住院时间、术后病死率)、疼痛评分和伤口满意度。 结果剑突下观察孔长度为(20±2)mm;平均手术时间(95.1±23.7)min;术中平均出血量(19.5±9.2)ml(除去中转手术);中转开胸率3.53 %(4/113);胸腺完整切除率100%;周围脂肪清扫率(92.37±6.5)%。术后平均住院时间(3.4±1.2)d(术后不留置引流管);术后无死亡病例;术后平均疼痛评分(VAS)为(2.3±0.3)分;患者切口满意度评分(93.0±5.6)分。 结论"三孔式"剑突肋缘下胸腺扩大切除术作为胸腺切除的新方法,不仅满足了传统手术观念所要求的"en bloc"切除原则,同时又兼顾了现代社会微创美观的要求。该术式在安全性和术后并发症等各方面均不劣于传统手术,可作为治疗重症肌无力的新方式,值得临床大力推广。

Thymus resection with " three holes" operation through subxiphoid and subcostal in the treatment of myasthenia gravis

ObjectiveTo evaluate the safety and effect of thymus resection with " three holes" operation through subxiphoid and subcostal in the treatment of myasthenia gravis. MethodsA total of 113 patients with myasthenia gravis undergoing thymus resection with "three holes" operation through subxiphoid and subcostal between December 2013 and July 2015 were enrolled. The general conditions of operation (length of incision, operation time, volume of bleeding, rate of transfer thoracotomy, rate of thymus complete resection, rate of peripheral fat cleaning, length of postoperative hospital stay, and postoperative mortality), pain score and the satisfaction degree of incision were observed. ResultsThe length of subxiphoid observation hole was (20±2) mm, the mean operation time was (95.1 ±23.7) min, the mean volume of bleeding was (19.5±9.2) ml (excluding transfer operation), the rate of transfer thoracotomy was 3.53% (4/113), the rate of thymus complete resection was 100%, and the rate of peripheral fat cleaning was (92.37±6.5)%. The mean length of postoperative hospital stay was (3.4 ±1.2) d (without drainage after operation), the postoperative mortality was 0, the mean postoperative pain score was 2.3 ±0.3, and the satisfaction degree of incision was 93.0 ±5.6. ConclusionsAs a new method for expanded thymus resection, the " three holes" operation through subxiphoid and subcostal not only meets the requirement of traditional operation concept of "en bloc" incision principle, but also takes into account the demand of minimally invasive appearance of modern society. This approach is not inferior to the traditional operation in safety and postoperative complications, and can serve as a new method of surgical treatment of myasthenia gravis.