胸腔镜下胸腺瘤扩大切除术治疗重症肌无力伴发胸腺瘤的临床疗效分析

目的探究胸腔镜下胸腺瘤扩大切除术治疗重症肌无力伴发胸腺瘤的临床疗效。方法将128例接受手术治疗的重症肌无力伴发胸腺瘤患者按照手术方式的不同,分为腔镜组78例(接受胸腔镜手术)和开放组50例(接受胸骨正中劈开手术)。比较两组患者围手术期指标及疗效,分别在麻醉前(T1)、麻醉后(T2)、切皮后2 h(T3)、术后24 h(T4)、术后48 h(T5)、术后72 h(T6)检测白细胞介素-6(IL-6)、IL-8水平。结果腔镜组患者术中出血量明显少于开放组,术后住院时间、引流管留置时间均明显短于开放组,差异均有统计学意义(P﹤0.01)。不同时间点腔镜组和开放组患者IL-6水平比较,差异均有统计学意义(F=2.563、3.019,P﹤0.05);不同时间点腔镜组和开放组患者IL-8水平比较,差异均有统计学意义(F=2.886、2.961,P﹤0.05)。T4时两组患者血浆中IL-6、IL-8水平均高于本组T1、T2、T3、T5、T6时,差异均有统计学意义(P﹤0.05)。在T4、T5、T6时,腔镜组患者IL-6、IL-8水平均低于开放组,差异均有统计学意义(P﹤0.05)。两组患者有效率及复发率比较,差异均无统计学意义(P﹥0.05)。结论胸腔镜胸腺瘤扩大切除术对重症肌无力伴发胸腺瘤患者安全可行,与胸骨正中劈开术疗效相当,但是在术后恢复、术中出血方面有优势。

Clinical effect of thoracoscopic extended thymectomy for patients with myasthenia gravis and thymoma

Objective To investigate the clinical efficacy of thoracoscopic extended thymectomy for patients with myasthenia gravis(MG)and thymoma.Method A total of 128 patients with MG complicated by thymoma who underwent surgical resection were retrospectively included in the study as thoracoscopic extended thymectomy group(with 78 patients receiving thoracoscopic resection)and open surgery group(with 50 cases administered with midline sternotomy).Perioperative measures and efficacy in the two groups were assessed and compared,and the levels of interleukin-6(IL-6)and IL-8 were detected at T1(before anesthesia),T2(after anesthesia),T3(2 h after incision),T4(24 h after surgery),T5(48 h after surgery)and T6(72 h after surgery).Result The intraoperative blood loss was significantly less in the thoracoscopic surgery group than in the open surgery group,same findings were observed in respect of postoperative hospital stay and the time of indwelling pleural catheter,the differences were statistically significant(P<0.01).The IL-6 levels varied significantly between thoracoscopic surgery group and open surgery group at different time points(F=2.563,3.019,P<0.05);similarly,the IL-8 levels were also different between the two groups at different time points(F=2.886,2.961,P<0.05).at T4,the plasma IL-6 and IL-8 levels in both groups were significantly increased compared to T1,T2,T3,T5 and T6(P<0.05).At T4,T5,and T6,the IL-6 and IL-8 levels in thoracoscopic surgery group were lower than those in the open surgery group,indicating statistically significant differences(P<0.05).In regard of the response rate and recurrence rate,a consistent pattern was noted between the two groups(P>0.05).Conclusion Thoracoscopic extended thymectomy is safe and feasible for patients with MG complicated by thymoma,demonstrating similar curative effect as compared with midline sternotomy,however,it is superior in promoting postoperative recovery and reducing intraoperative blood loss.