摘要
目的比较电视胸腔镜手术(VATS)与胸骨正中切口胸腺扩大切除治疗非胸腺瘤重症肌无力(NT-MG)的中期疗效和生活质量,以合理选择手术方式。方法回顾性分析该科2003年5月～2006年6月行胸腺扩大切除治疗NTMG52例,根据手术方式的不同分为VATS组(n=26)和开胸组(n=26),术后3年随访时采用术后MG相关症状变化DeFilippi分级和美国重症肌无力基金会MG评分(MGFA评分)分析术后疗效。采用欧洲癌症研究和治疗组织(EORTC)生活质量问卷(QLQ)评估术后生活质量。结果开胸组发生肌无力危象1例,VATS组无发生。术后3年随访时MG相关症状变化DeFilippi分级,VATS组患者症状改善优于开胸组(P<0.05),且MGFA评分VATS组优于开胸组(P<0.05);而VATS组和与开胸组总有效率分别为100%(26/26)和80.8%(21/26),两组差异无显著性(P>0.05),EORTC-QLQ6项(包括躯体、角色、认知、情绪、社会、总生活质量)评分两组差异无显著性(P>0.05)。结论 VATS胸腺扩大切除作为治疗NTMG的一种有效方法,具有良好临床应用前景。
[Objective] To investigate the value of video-assisted thoracoscopic surgery（VATS） in the treatment of nonthymomatous myasthenia gravis（NTMG） by comparing the medium-term efficacy and quality of life after extensive thymectomy of VATS and median sternotomy.[Methods] A retrospective analysis on 52 cases of NTMG,who were preoperatively confirmed to be NTMG from May 2003 to June 2006 were divided into VATS group（26 cases） and conventional thoracotomy group（26 cases）;Clinical efficacy was measured by DeFlippi class for changes in myasthenia gravis-associated symptoms and MGFA score,quality of life was studied by modified the European Organization for Research and Treatment of Cancer（EORTC） quality-of-life questionnaire（QLQ） at 3-years of the follow-up.[Results] 1 cases occurred muscle weakness crises in open-chest group,but none in VATS group.At 3-years of the follow-up,symptoms improved of patients with VATS better than open-chest group（P 0.05）,and the VATS group was higher than chest group in MGFA score（P 0.05）,total effectiveness with VATS group and open-chest group were 100%（26/26） and 80.8%（21/26）,and statistics in two groups was not significant（P 0.05）,six item score of EORTC-QLQ（Physical,Role,Cognitive,Emotional,Social,Global ability） of VATS group is superior over conventional group（P 0.05）.[Conclusions] VATS thymectomy can be regarded as the treatment of choice for patients undergoing surgery for nonthymomatous myasthenia gravis,it will has a wonderful applied future of clinic.
出处
《中国内镜杂志》
CSCD
北大核心
2011年第8期817-820,共4页
China Journal of Endoscopy
关键词
电视胸腔镜手术
胸腺扩大切除
重症肌无力
生活质量
video-assisted thoracoscopic surgery
extended thymectomy
myasthenia gravis
quality of life
