电视胸腔镜下手术治疗胸腺瘤与传统手术治疗的临床对比研究

目的探讨电视胸腔镜下治疗胸腺瘤的临床应用价值。方法将2008年7月至2013年4月确诊为胸腺瘤61例适合采用手术治疗的患者随机分为A组(胸腔镜组)31例和B组(传统手术组)30例。治疗后观察两组手术临床资料、肺功能、术后并发症、复发等方面指标。结果 A组在术中出血量、手术时间、切口长度方面均小于B组,A组胸管引流时间、引流量、住院时间、术后疼痛评分、止痛药物应用情况优于B组,两组比较差异具有显著性(P0.01);A组治疗后在第1秒用力呼气量(FEV1)、最大呼气量(FVC)与治疗前比较无明显变化(P0.05),B组治疗后FEV1、FVC与疲劳指数(Fatigue index)较治疗前有明显下降(P0.05);两组术后比较,A组FEV1、FVC高于B组,疲劳指数低于B组,具有显著性差异(P0.05)。A组上肢运动障碍发生率低于B组,差异具有显著性(P0.05)。两组并发症、复发或死亡发生情况差异无显著性(P0.05)。结论电视胸腔镜治疗胸腺瘤能达到与传统手术一样的疗效,具有切口小,并发症少,术后恢复快,具有和开胸组相当的近期肿瘤根治效果,是一种安全、可行、临床效果好的微创术式。

Study on clinical comparison of thoracoscopic thymectomy versus open surgery in treatment of thymoma

Objective To explore the clinical effect of thoracoscopic thymectomy in treatment of thymoma. Methods A total of 61 pa-tients with thymoma during June 2008 to April 2013 were randomly divided into group A（VATS group,n=31）and group B（trans-sternal open thymectomy group,n=30）. The clinical data,postoperative complications and perioperative mortality of these patients were observed and com-pared. Results In comparison with group B,patients in group A had significantly shorter operating time,less blood loss,shorter postoperative hospitalization stay,shorter incision length,lower postoperative pain scores,less analgesic doses,shorter duration of chest tube drainage and less amount of chest drainage（ P 〈0. 01）. Index of fatigue in these two groups was significantly increased（ P 〈0. 05）. The FEV1 and FVC in group B had obvious change compared with those before treatment（ P 〈0. 05）,and they were significantly increased in control group compared with those of observation group（ P 〈0. 05）. The difference in postoperative FEV1,FVC and Fatigue index was significant（ P 〈0. 05）. Conclusion Thoracoscopic thymectomy is a safe,feasible,effective and minimally invasive procedure for treatment of thymoma,it has less complications and quick recovery and it also has similar short-term outcome with conventional open thymectomy.