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[1]江文坛,杨建胜,林良安,等.剑突下胸腔镜胸腺切除术的安全性和可行性研究[J].福建医科大学学报,2020,54(01):40-43.
 JIANG Wentan,YANG Jiansheng,LIN Liang'an,et al.Safety and Feasibility Study of Subxiphoid Thoracoscopic Thymectomy[J].Journal of Fujian Medical University,2020,54(01):40-43.
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《福建医科大学学报》[ISSN:1672-4194/CN:35-1192/R]

卷:
第54卷
期数:
2020年01期
页码:
40-43
栏目:
临床研究
出版日期:
2020-02-28

文章信息/Info

Title:
Safety and Feasibility Study of Subxiphoid Thoracoscopic Thymectomy
文章编号:
1672-4194(2020)01-0040-04
作者:
江文坛 杨建胜 林良安 吴敬阳 林贤宾
福建医科大学 附属第二医院胸外科,泉州 362000
Author(s):
JIANG Wentan YANG Jiansheng LIN Liang'an WU Jingyang LIN Xianbin
Department of Thoracic Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000,China
关键词:
胸腔镜 剑突 胸腺切除术 胸腺肿瘤 重症肌无力
Keywords:
thoracoscopes xiphoid bone thymectomy thymus neoplasms myasthenia gravis
分类号:
R655; R655.3; R736.3; R746.1
DOI:
-
文献标志码:
A
摘要:
目的 探讨剑突下胸腔镜胸腺切除治疗胸腺肿瘤及重症肌无力(MG)的安全性和可行性。 方法 回顾性分析54例接受胸腔镜胸腺切除术患者的临床资料,其中剑突下胸腔镜胸腺切除术27例,经肋间胸腔镜胸腺切除术27例,分析比较两组的临床指标、术后疼痛评分及并发症等情况。 结果 所有患者均顺利实施手术,无术中麻醉意外情况出现,剑突下组无中转开胸,肋间组中转开胸1例。剑突下组的手术时间、术中出血量、术后胸液量及胸管留置时间,与肋间组比较差别无统计学意义(P>0.05); 剑突下组术后住院时间明显少于肋间组,分别为(4.22±1.99)d和(7.44±2.12)d,两组比较差别有统计学意义(P<0.05); 剑突下组术后24,48,72 h疼痛视觉模拟评分(VAS)明显低于肋间组,分别为(2.52±0.85),(1.74±0.81),(1.33±0.73)分和(3.74±1.97),(2.63±1.80),(2.00±1.57)分,两组各时间点比较差别均有统计学意义(P<0.05); 剑突下组围术期并发症低于肋间组,分别为7.4%和18.5%,但差别无统计学意义(P>0.05)。 结论 剑突下胸腔镜胸腺切除术安全、可行,具有疼痛轻、恢复快等优点,是治疗胸腺肿瘤和MG较为完美的手术方法,适合推广。
Abstract:
Objective To explore the safety and feasibility of subxiphoid thymectomy for thymic tumor and myasthenia gravis. Methods A retrospective analysis was made of 54 patients who underwent thoracoscopic thymectomy since 2014. Among them, 27 underwent subxiphoid thymectomy and 27 underwent intercostal thymectomy. The clinical indicators, post-operative pain scores, and complications of the two groups were analyzed. Results All operations were carried out smoothly. No intraoperative anesthesia accident occurred. There was no conversion to thoracotomy in subxiphoid group and there was 1 case of the conversion in intercostal group. There was no significant difference in operation time, intraoperative bleeding volume, postoperative pleural fluid volume, and thoracic tube indwelling time between the subxiphoid group and the intercostal group(P>0.05). The hospitalization time in the subxiphoid group was significantly shorter than that in the intercostal group [(4.22±1.99)days vs(7.44±2.12)days], and the difference was significant(P<0.05). The VAS scores of Subxiphoid group at 24, 48, and 72 hours after operation were significantly lower than those in the intercostal group[(2.52±0.85),(1.74±0.81), and(1.33±0.73)vs(3.74±1.97),(2.63±1.80), and(2.00±1.57)]. The differences between the two groups were signifcant(P<0.05). Perioperative complications in Subxiphoid group were lower than those in intercostal group(7.4% vs 18.5%), but there was no significant difference(P>0.05). Conclusion Subxiphoid thymectomy is safe and feasible, with light pain and quick recovery. It is a relatively perfect surgical method for thymic tumor and myasthenia gravis.

参考文献/References:

[1] 方文涛,傅剑华,沈 毅,等. 胸腺肿瘤的诊疗:基于中国胸腺肿瘤协作组多中心回顾性研究的共识[J]. 中国肺癌杂志,2016,19(7):414-416.
[2] Wright C D, Kessler K A. Surgical treatment of thymic tumors[J]. Semin Thorac Cardiovasc Surg, 2005,17(1):20-26.
[3] Toker A, Sonett J, Zielinski M, et al. Standard terms, definitions, and policies for minimally invasive resection of thymoma[J]. 中国肺癌杂志, 2014,17(2):90-93.
[4] Sugarbaker D J. Thoracoscopy in the management of anterior mediastinal masses[J]. Ann Thorac Surg, 1993,56(3): 653-656.
[5] 张 毅, 支修益, 许庆生, 等. 电视胸腔镜下扩大胸腺切除治疗重症肌无力[J]. 中国胸心血管外科临床杂志, 2008,15(6):473-474.
[6] Xie A, Tjahjono R, Phan K, et al. Video-assisted thoracoscopic surgery versus open thymectomy for thymoma: a systematic review[J]. Ann Cardiothorac Surg, 2015, 4(6): 495-508.
[7] Chen S X, Chen S J, Xu J J, et al. Single port thoracoscopy surgery in treatment of anterior mediastinal tumor[J]. Chin J Clin Thorac Cardiovasc Surg, 2016, 23(6): 634-635.
[8] Hsu C P, Chuang C Y, Hsu N Y, et al. Subxiphoid approach for video-assisted thoracoscopic extended thymectomy in treating myasthenia gravis[J]. Interact Cardiovasc Thorac Surg, 2002, 1(1): 4-8.
[9] Suda T, Ashikari S, Tochii D, et al. Dual-port thymectomy using subxiphoid approach[J]. Gen Thorac Cardiovasc Surg, 2014, 62(9): 570-572.
[10] Suda T, Hachimaru A, Tochii D, et al. Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: initial resultsdagger[J]. Eur J Cardiothorac Surg, 2016, 49(1): 154-158.
[11] 卢 强, 李小飞, 陈 召, 等. 新型“三孔式”微创术式治疗重症肌无力[J]. 中华胸心血管外科杂志, 2016,32(5):287-288.
[12] 汪 灏, 李继军, 丁建勇, 等. 胸骨抬举法辅助经剑突下胸腔镜微创手术治疗胸腺病变的初步尝试[J]. 中国临床医学, 2017,24(2):188-190.
[13] 陈舒晨, 余绍斌, 林济红, 等. 经剑突下入路胸腔镜下前纵隔肿瘤切除术学习曲线分析[J]. 福建医科大学学报, 2017,51(5):311-314.

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备注/Memo

备注/Memo:
收稿日期: 2019-01-30 基金项目: 泉州市科技计划项目(2018Z101) 作者简介: 江文坛,男,主治医师,医学硕士 通讯作者: 杨建胜. Email: jianson@163.com
更新日期/Last Update: 2020-01-30