小切口半劈胸骨行胸腺切除术治疗重症肌无力.docxVIP

小切口半劈胸骨行胸腺切除术治疗重症肌无力 王保中刘金山 (河北省保定市第一中心医院心胸外科071000) 【摘要】目的 探讨小切口半劈胸骨行胸腺切除术治疗重症肌无力的手术效 果和影响因素及52例手术的经验总结。方法52例均采用正中切口小切口半劈 胸骨进胸，切除胸腺及前纵隔所有脂肪组织，其中有外侵表现者，则切除受累之 胸膜、心包、动脉外膜，并按临床症状分型、镜下病理分型、临床病理分期、是 否根治切除分别分类，统计缓解、改善、无变化、恶化的例数，缓解和改善视为 有效，无变化和恶化视为无效，以有效和无效例数行X 2检验。结果木组52例 病例，总有效率82.7% (43 / 52),无变化5例,9.7%,恶化4例，5.8%,其中 死亡1例。平均手术时间89.3plusmn;24.7min(53min-176min),术中大血管损伤 出血0例，全部病例术中失血量lt;200ml,术后引流量lt;200ml,纵膈感染0 例，切口感染1例(1.92%),术后平均住院日6.7plusmn;3.8天。临床症状分型 和镜下病理分型对手术效果的影响无显著性差异(Pgt;0.05),临床病理分期和 是否根治切除对手术效果的影响存在显著性差异(Plt;0.05)o结论临床症状分 型对手术疗效有一定影响，III型有效率明显降低，但统计学分析对疗效的影响无 显著性差异，提示无论临床分型如何，均应手术，原发性胸腺癌不易根治性切除， 但就手术切除对重症肌无力症状改善来看，良恶性肿瘤差异不大，Masaoka分 期与胸腺瘤并发重症肌无力的预后密切相关，就改善肌无力症状来看，I期、II 期、III期和IV期之间也存在显著性差异，以II期效果最好。小切口半劈胸骨行胸 腺根治切除术，手术时间短，出血量少,恢复快，优于传统正中开胸手术，手术效果可 靠，适宜在基层医院推广。 【关键词】胸腺瘤 重症肌无力 半劈胸骨 【中图分类号】R734.3 【文献标识码】A 【文章编号】1672-5085 (2014) 03-0072-03 【Abstract] Objective: Explore small cut half-cut line sternum thymus gland excision treatment and myasthenia gravis the surgical results and impact factors and 52 cases of surgery experience..Methocls: 52 cases are made of a small incision into the chest incision half sternotomy, removal of the thymus and all anterior mediastinal fat tissue, which has foreign invasion performers, the removal of the pleura, pericardium, arterial involvement of the outer membrane, and then typing of clinical symptoms, mirror under pathological type, clinical staging, whether radical resection were class市ed statistics remission, improvement, no change in the number of cases of deterioration, alleviate and improve as valid, no change and deterioration deemed in valid to valid and in valid cases the nu mber of rows X2 test.Results： The group of 52 cases, the total efficiency of 82.7% (43/52), unchanged in 5 cases, 9.7%, deterioration of four cases, 5.8%, of which 1 died. The mean operative time 89.3 plusmn; 24.7min (53min-176min), intraoperative bleeding 0 cases of vascular injury, all cases of intraoperative blood loss lt;200ml, postoperative drain