摘要【目的】探讨胸腔镜下胸腺扩大切除术治疗重症肌无力(MG)患者合并微小胸腺瘤和合并胸腺增生的手术情况、预后情况及疗效。【方法】选择2012年7月至2016年7月于本院就诊的MG患者84例作为研究对象,按合并微小胸腺瘤和合并胸腺增生分为微小胸腺瘤组( n =46)和胸腺增生组( n =38)两组。患者均给予胸腔镜下胸腺扩大切除术治疗,观察并记录两组患者的手术效果、术后6个月随访预后情况。对患者一般资料、胸腺病理类型与疗效的关系进行单因素分析,并应用Logistic回归模型对影响因素进行多因素分析。【结果】对于一般资料中的年龄小于40岁的疗效明显优于大于40岁的人;两组患者的手术时间、术中出血量、切口总长度,引流管滞留时间,住院时间等手术基本情况比较,差异无统计学意义( P >0.05);两组术后并发症比较无统计学意义( P >0.05);术后随访6个月,术后病理胸腺增生组疗效优于微小胸腺瘤组;logistic回归模型中年龄与术后病理比较,年龄仍是最重要影响因素。【结论】通过logistic回归分析,MG合并微小胸腺瘤者术前症状重,应用胸腔镜扩大切除术治疗MG合并微小胸腺瘤,手术效果肯定,但手术较合并胸腺增生者治疗效果稍差,术后并发症无差异,术后恢复快,值得临床推广应用。
Abstract：【Objective】To investigate the operation, prognosis and curative effect of thoracoscopic thymic enlargement in the treatment of patients with myasthenia gravis (MG) complicated with microthymoma and thymic hyperplasia.【Methods】 A total of 84 patients with MG who were admitted to our hospital from July 2012 to July 2016 were enrolled. The patients were divided into the small thymoma group ( n =46) and the thymic hyperplasia group( n =38)according to the combination of microthymoma or thymic hyperplasia. All patients underwent thoracoscopic thymectomy, and the surgical results of the two groups were observed and the prognosis was followed up for 6 months. Univariate analysis was performed on the relationship between patients' general data, thymic pathology type and curative effect, and logistic regression model was used to analyze the influencing factors.【Results】For the general data, the effect of age less than 40 years was significantly better than that of those older than 40 years old. The operation time, intraoperative blood loss, total length of incision, drainage tube retention time, hospitalization time and other basic conditions were compared between the two groups. The difference was not statistically significant ( P > 0.05). There was no significant difference in postoperative complications between the two groups ( P > 0.05). After follow-up for 6 months, the postoperative pathological thymic hyperplasia group was better than the small thymoma group. In the logistic regression model, age was still the most important factor in comparison with postoperative pathology.【Conclusion】By logistic regression analysis, the patients with MG complicated with small thymoma had severe symptoms before operation. The effect of thoracoscopic extended resection on MG with microthymoma was positive, but the effect of operation was a little worse than that of patients with thymus hyperplasia, and there was no difference in postoperative complications. It is worth popularizing and applying in clinic because of the quick recovery after operation.
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2018, Vol. 35 
