目的 比较重症肌无力两种微创胸腺扩大切除术的长期疗效。方法 回顾性分析2010-06至2014-06原火箭军总医院采用两种微创方法行胸腺扩大切除术治疗的50例重症肌无力患者的临床资料及随访结果,两种术式的围术期结果比较采用χ2检验,远期疗效采用Kaplan-Meier法绘制有效率-时间曲线,log-rank法进行统计分析。结果 机器人组和胸腔镜组均顺利完成微创胸腺扩大切除术,均无中转开胸及围术期死亡。术后共发生肌无力危象4例(8.0%)。平均随访73.3个月,完全缓解率为34%(17/50),治疗总有效率为86.0%(43/50)。机器人组有效率和完全缓解率与胸腔镜组比较,差异无统计学意义。Osserman Ⅰ型有效率达100%,明显高于其他类型,差异有统计学意义(P<0.05)。性别、年龄、病理、手术方式和病程对5年累积有效率的影响无统计学意义。结论 胸腔镜和机器人胸腺切除术治疗重症肌无力安全、可行,长期疗效满意,两种术式对预后影响无统计学差异。
Abstract
Objective To explore the long term results of two types of minimally invasive thymectomy(MIT) for myasthenia gravis(MG).Methods Fifty patients diagnosed with MG underwent video-assisted and robotic-assisted thoracoscopic thymectomy between June 2010 and June 2014 and were followed up till June 2018. The perioperative results of the two groups were analyzed by χ2 test, and the long term effects were evaluated by the Kaplan-Meier method and log-rank test.Results All the patients underwent minimally invasive thymectomy smoothly, with no conversions to thoracotomy or death. A total of 4 cases (8.0%) encountered myasthenic crisis. After 73.3 months of follow-up, the complete remission rate and overall effective rate were 34% (17/50) and 86.0% (43/50) respectively, and there was no significant difference between the two groups. According to Osserman’s criteria, patients classified as type Ⅰ displayed a significant higher effective rate than other groups by univariate analysis. No significant difference was found in the remission rate according to the gender, age, pathology, surgical procedures and the duration of symptoms.Conclusions Video-assisted and robotic-assisted thoracoscopic thymectomy are both safe and feasible for MG patients and may bring about equally favorable prognosis.
关键词
重症肌无力 /
微创外科 /
胸腺扩大切除术 /
免疫治疗
Key words
myasthenia gravis /
minimally invasive surgery /
extensive thymectomy /
immunotherapy
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参考文献
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