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·胸部疾病·

胸腔镜+人工气胸术在重症肌无力患者外科手术治疗中的应用

作者:陈保坤

所属单位:北京大学深圳医院胸外科 (广东 深圳 518036)

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摘要

目的 分析重症肌无力(MG)采用人工气胸术联合胸腔镜治疗的效果。方法 选取我院收治的MG患者98例,随机分成 研究组和对照组,每组分别为49例病患。对照组行常规胸腔镜手术,治疗组行胸腔镜+人工气胸术,比较两组的症 状缓解效果、视野暴露情况、出血量、手术时间、住院时间、并发症。结果 ①有效率:治疗组、对照组分别为 95.92%、81.63%,组别间比较具有差异性(P<0.05);②术野完全暴露率:治疗组为89.80%,对照组为59.18%,治 疗组术野暴露情况比对照组更好,对比有差异(P<0.05);③治疗组术中出血量、住院以及手术时间均比对照组 小,两组对比有统计学意义(P<0.05);④并发症率:对照组、治疗组各为14.29%、2.04%,治疗组并发症较低,与 对照组比较有差异(P<0.05)。结论 采用腹腔镜联合人工气胸术对MG病患进行治疗,能控制并发症率,缩短手术以 及住院时间,促进病患术后身体恢复,值得临床推广。

Objective To analyze the effect of thoracoscopy combined with artificial pneumothorax in the treatment of myasthenia gravis(MG). Methods A total of 98 MG patients in our hospital were taken as the clinical research objects, and they were randomly divided into study group (49 cases) and control group(49 cases). Both groups were given conventional thoracoscopic surgery, besides, the study group was given additional artificial pneumothorax. The alleviating effects, visual field exposure, blood loss, operation time, hospital stay and complications in the two groups were compared. Results: The effective rate in the study group was 95.92% which was obviously higher than that in the control group 81.63%, and their difference was statistically significant(P<0.05), the complete exposure rate of visual field in the study group was 89.80% which was obviously better than that in the control group 59.18%, and their difference was statistically significant(P<0.05), the blood loss, operation time and hospital stay in the study group were all lower than those in the control group, and their differences were statistically significant(P<0.05), the incidence rate of complication in the study group was 2.04% which was obviously lower than that in the control group 14.29%, and their difference was statistically significant(P<0.05). Conclusion Thoracoscopy combined with artificial pneumothorax for MG patients can control complication rate, shorten operation time and hospital stay, and promote recovery. Thus, it is worthy of clinical application.

【关键词】人工气胸;腹腔镜;重症肌无力;治疗效果

【中图分类号】R746.1

【文献标识码】A

【DOI】10.3969/j.issn.1009-3257.2017.03.012

前言

MG是一种自身免疫性疾病,主要表现为神经肌肉 传导障碍,部分病患合并其他病症,如干燥综合征、 系统性红斑狼疮、甲状腺炎、甲亢等,治疗比较棘 手。针对该疾病,临床主要采用手术、药物两种方式 进行治疗[1]。随着医疗技术越来越成熟,胸腔镜胸腺 切除术在MG手术治疗中广泛应用,值得注意的是,该 术式操作空间较小,心脏跳动以及肺部组织对手术视 野具有一定干扰作用,增加了手术难度[2]。胸腔镜+ 人工气胸术则能弥补传统手术不足,使手术视野更加 清晰,增加操作空间,为了分析该术式在MG手术治疗中的应用效果,我院选择了98例病患进行研究,现报 道如下。