胸腔镜剑突肋缘下与单侧胸腔镜胸腺扩大切除术治疗重症肌无力疗效对比的倾向性评分匹配分析

目的通过倾向性评分匹配,对比分析胸腔镜剑突肋缘下及单侧胸腔镜胸腺扩大切除术在治疗合并胸腺异常重症肌无力患者的临床效果,探讨并评价胸腔镜剑突肋缘下胸腺扩大切除术的临床疗效。方法回顾性分析2011年12月至2018年12月于空军军医大学唐都医院胸外科同一诊疗组接受手术治疗612例重症肌无力患者的临床资料。按照手术入路将患者分为胸腔镜剑突肋缘下胸腺扩大切除术组(剑突组,520例)和单侧胸腔镜胸腺扩大切除术组(单侧组,92例)。经倾向性评分匹配,剑突组获得与单侧组术前基线资料差异无统计学意义的92例患者,其中剑突组男52例、女40例,年龄26~70(50.2±10.3)岁;单侧组男47例、女45例,年龄20~73(51.5±12.1)岁。对比分析两组患者的手术时间、术中出血量、胸腔引流时间、术后住院时间、脂肪清扫彻底性、术后肌无力缓解情况、患者满意情况、疼痛情况及并发症等指标。结果两组均顺利完成手术,均无中转开胸。剑突组、单侧组在手术时间(46.2±19.5)min vs.(53.4±23.5)min]、胸腔引流时间0 d vs.(3.4±1.2)d]、术后住院时间(2.9±1.9)d vs.(3.6±1.7)d]、患者满意度评分(7.9±2.1)分vs.(6.7±1.2)分]等方面差异均有统计学意义(P均<0.05)。两组在术中出血量(52.2±12.7)mL vs.(51.2±10.3)mL]、脂肪清扫彻底性(8.1±0.6 vs.7.9±0.9)、术后肌无力缓解率(89.1%vs.85.9%)、总体并发症发生率(10.9%vs.6.5%)方面差异均无统计学意义(P均>0.05)。结论对于合并胸腺异常的重症肌无力患者,胸腔镜剑突肋缘下胸腺扩大切除术是一种更有效的手术方式。

Subxiphoid and subcostal arch thoracoscopic versus unilateral thoracoscopic thymectomy for the treatment of thymic abnormalities with myasthenia gravis:A propensity-score matching study

Objective To compare clinical effects of extended thymectomy for the treatment of thymic abnormalities with myasthenia gravis(MG)between subxiphoid and subcostal arch thoracoscopic resection(SR)and the unilateral thoracoscopic resection(UR)by a propensity-score matching analysis.Methods We retrospectively analyzed the clinical data of 612 patients who presented with MG and were admitted to Tangdu Hospital of Air Force Military Medical University between December 2011 and December 2018.Of these patients,520 patients underwent subxiphoid and subcostal arch thoracoscopic extended thymectomy(a SR group)and 92 unilateral thoracoscopic extended thymectomy(a UR group).Ninety-two patients in the SR group were matched with the UR group by propensity-score matching analysis.There were 52 males and 40 females with an average age of 26-70(50.2±10.3)years in the SR group,and 47 males and 45 females with an average age of 20-73(51.5±12.1)years in the UR group.The operation time,intraoperative blood loss,thoracic drainage time,postoperative hospital stay,thorough adipose tissue removal,postoperative remission of MG,patients’satisfaction score,pain and complications were compared and analyzed between the two groups.Results All operations were accomplished successfully,without conversion to thoracotomy of the two groups.There were statistical differences between the two groups in operation time(46.2±19.5 min vs.53.4±23.5 min),chest drainage duration(0 d vs.3.4±1.2 d),hospital stay(2.9±1.9 d vs.3.6±1.7 d),patients’satisfaction score(7.9±2.1 points vs.6.7±1.2 points)and pain scores(all P<0.05).There were no statistical differences between the two groups in intraoperative blood loss(52.2±12.7 mL vs.51.2±10.3 mL),peripheral adipose tissue removal(8.1±0.6 vs.7.9±0.9),remission rate of MG(89.1%vs.85.9%)and rate of postoperative complications(10.9%vs.6.5%)(all P>0.05).Conclusion Subxiphoid and subcostal arch thoracoscopic extended thymectomy is a safe and feasible minimally invasive procedure for the management of MG with thymic abnormalities.