目的 探讨结合肋缘下切口的剑突入路胸腔镜胸腺扩大切除治疗重症肌无力的手术安全性与临床疗效。 方法 回顾性分析 2015 年 10 月至 2016 年 4 月期间我院心胸外科收治的 23 例重症肌无力合并胸腺疾病患者的临床资料。其中男 8 例、女 15 例，年龄 11～70（40.70±17.31）岁。所有患者采用经剑突入路胸腔镜胸腺扩大切除手术。 结果 所有手术均成功，无中转开胸或延长手术切口长度患者。患者切口长度平均（2.76±0.40）cm，手术时间平均（138.4±35.4）min，术中出血量平均（35.2±28.6）ml，术后呼吸机辅助时间平均（13.40±9.84）h，采用延迟拔管 1 例，术后并发症 2 例，其中少量胸腔积液 1 例、肺炎 1 例。术后疼痛视觉模拟（VAS）评分平均 2.77 分。 结论 剑突入路胸腔镜胸腺扩大切除技术是安全可行的手术方式，具有容易操作、清扫彻底、手术创伤小、恢复快、美容效果好等优点，值得深入研究及进一步推广。
ObjectiveTo evaluate the effectiveness and safety of proximal aortic repair (PAR) versus total arch replacement (TAR) for treatment of acute type A aortic dissection (ATAAD). Methods An electronic search was conducted for clinical controlled studies on PAR versus TAR for patients with ATAAD published in Medline via PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang Database and CNKI since their inception up to April 30, 2022. The quality of each study included was assessed by 2 evaluators and the necessary data were extracted. STATA 16 software was used to perform statistical analysis of the available data. ResultsA total of 28 cohort studies involving 7 923 patients with ATAAD were included in this meta-analysis, of whom 5 710 patients received PAR and 2 213 patients underwent TAR, and 96.43% of the studies (27/28) were rated as high quality. The meta-analysis results showed that: (1) patients who underwent PAR had lower incidences of 30 d mortality [RR=0.62, 95%CI (0.50, 0.77), P＜0.001], in-hospital mortality [RR=0.64, 95%CI (0.54, 0.77), P＜0.001], and neurologic deficiency after surgery [RR=0.84, 95%CI (0.72, 0.98), P=0.032] than those who received TAR; (2) the cardiopulmonary bypass time [WMD=–52.07, 95%CI (–74.19, –29.94), P＜0.001], circulatory arrest time [WMD=–10.14, 95%CI (–15.02, –5.26), P＜0.001], and operation time [WMD=–101.68, 95%CI (–178.63, –24.73), P＜0.001] were significantly shorter in PAR than those in TAR; (3) there was no statistical difference in mortality after discharge, rate of over 5-year survival, renal failure after surgery and re-intervention, volume of red blood cells transfusion and fresh-frozen plasma transfusion, or hospital stay between two surgical procedures. Conclusion Compared with TAR, PAR has a shorter operation time and lower early and in-hospital mortality, but there is no difference in long-term outcomes or complications between the two procedures for patients with ATAAD.