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中华胸部外科电子杂志 ›› 2016, Vol. 03 ›› Issue (02) : 95 -99. doi: 10.3877/cma.j.issn.2095-8773.2016.02.006

所属专题: 文献

论著

"三孔式"经剑突肋缘下胸腺切除治疗重症肌无力
卢强1, 李小飞1, 赵晋波1, 王居正1, 陈召1, 张天翼1, 周勇安1,()   
  1. 1. 710038 西安,第四军医大学唐都医院胸腔外科
  • 收稿日期:2016-04-18 出版日期:2016-05-28
  • 通信作者: 周勇安
  • 基金资助:
    国家自然科学基金青年基金(81301069); 第四军医大学唐都医院科技创新发展基金(2014LCYJ003)

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

Qiang Lu1, Xiaofei Li1, Jinbo Zhao1, Juzheng Wang1, Zhao Chen1, Tianyi Zhang1, Yongan Zhou1,()   

  1. 1. Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi’an 710038, China
  • Received:2016-04-18 Published:2016-05-28
  • Corresponding author: Yongan Zhou
  • About author:
    Corresponding author: Zhou Yongan, Email:
引用本文:

卢强, 李小飞, 赵晋波, 王居正, 陈召, 张天翼, 周勇安. "三孔式"经剑突肋缘下胸腺切除治疗重症肌无力[J]. 中华胸部外科电子杂志, 2016, 03(02): 95-99.

Qiang Lu, Xiaofei Li, Jinbo Zhao, Juzheng Wang, Zhao Chen, Tianyi Zhang, Yongan Zhou. Thymus resection with " three holes" operation through subxiphoid and subcostal in the treatment of myasthenia gravis[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2016, 03(02): 95-99.

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。

Objective

To evaluate the safety and effect of thymus resection with " three holes" operation through subxiphoid and subcostal in the treatment of myasthenia gravis.

Methods

A 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.

Results

The 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.

Conclusions

As 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.

表1 113例重症肌无力患者的临床资料
图1 "三孔式"经剑突肋缘下胸腺切除操作过程。A、B:"三孔式"剑突下切口;C:胸骨后前纵隔术野
表2 重症肌无力患者行"三孔式"手术的一般情况、疼痛评分和伤口满意度(113例)
表3 "三孔式"术后并发症(113例)
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