经胸腔镜胸腺扩大切除术治疗重症肌无力42例报告

目的总结胸腔镜胸腺扩大切除治疗重症肌无力的经验。方法42例重症肌无力患者行胸腔镜或胸腔镜辅助小切口手术，切除范围包括胸腺组织及前上纵隔的脂肪软组织。结果手术均顺利完成，全组均无中转开胸。平均手术时间116.3（65-165）min，术中平均出血量为81.7（52-110）ml，术后平均住院时间为8.5（6-16）d。术后发生重症肌无力危象2例，予机械辅助通气及对症处理后好转。术后病理示26例为胸腺增生，16例为胸腺瘤。35例获随访，平均27.2（4-43）月，完全缓解7例，改善27例，1例无明显改善。结论胸腔镜胸腺扩大切除治疗重症肌无力，方法可行、可靠，具有创伤小、恢复快的优点。

Video-assisted Thoracoscopic Extended Thymectomy for Myasthenia Gravis(A Report of 42 Cases)

Objective To review the treatment experience of extended thymectomy for myasthenia gravis by video-assisted thoracoscopic surgery（VATS）.Methods 42 cases of myasthenia gravis were underwent extended thymectomy by VATS.The excision extension was included of thymus tissue and adipose tissue in anterior superior mediastinum.Results The mean operative duration,mean intraoperative blood loss and mean postoperative hospital stay was 116.3 minutes,81.7 ml and 8.5 days respectively.No one converted to open operation.Myasthenia gravis crisis occurred in 2 cases and was improved by mechanical assisted ventilation and symptomatic treatment.The pathological examination demonstrated thymic hyperplasia was in 26 cases and thymoma in 16 cases.35 cases were followed up for 4 to 43 months.There were 7 cases of complete remission,27 of relief and 1 of failed according to Osserman classification. Conclusion Thoracoscopic extended thymectomy is feasible and reliable for myasthenia gravis with advantages as minimal invasion and rapid recovery.