胸腔镜胸腺扩大切除治疗重症肌无力的远期疗效分析

目的评价胸腔镜胸腺切除术治疗重症肌无力的长期效果。方法对5年来同一医院行胸腔镜胸腺切除术治疗重症肌无力的患者的资料进行回顾性研究。资料收集来自病历记录和电话随访。自2001年11月至2005年5月,连续18例重症肌无力患者接受了同一手术小组完成的胸腔镜胸腺切除术。其中男7例,女11例,年龄19～48岁,平均33.4岁±9.4岁。多数经右侧入路完成胸腔镜下胸腺切除和前纵隔脂肪组织清除术。结果术后平均闭式引流2.1d±1.2d,平均术后住院6.3d±3.1d。围术期呼吸机辅助通气占28%(5/18),其中3例为术后短时间呼吸机辅助通气(不超过72h),另2例由于胆碱能或肌无力危象导致二次气管插管。全组失访2例,无死亡。随访时间26.4个月±10.9个月。根据美国重症肌无力基金会(MGFA)制定的标准进行疗效判定,9例(50%)完全稳定缓解(CSR),6例(33.3%)部分缓解,1例稳定(5.6%)。本组总有效率为83.3%。结论胸腔镜胸腺切除治疗重症肌无力安全可靠,长期效果肯定,疗效等同于其他传统方法。

Long-term effects of video-assisted thoracoscopic thymectomy for myasthenia gravis: 5-year follow-up of 18 cases

OBJECTIVE: To evaluate the long-term effects of video-assisted thoracoscopic thymectomy for myasthenia gravis (MG). METHODS: Eighteen MG patients, 7 males and 11 females, aged 33.4 +/- 9.4 (19 - 48), underwent video-assisted thoracoscopic thymectomy by the same surgical group from November 2001 to May 2005. Right side access was used in 14 of them, left side approach was used in 2, and bilateral approach in 1 of them. The thymus and fatty tissue in the front mediastinum were resected. The medical records were reviewed and telephone survey was conducted to understand the effects. The mean follow-up time was 26.4 +/- 10.9 months. RESULTS: VATS was successfully conducted except in 1 case. The bleeding volume was less than 50 ml. The average chest tube drainage time was 2.1 +/- 1.2 days, and the mean hospitalization day was 6.3 +/- 3.1 days. Three of the 18 patients needed temporary mechanical ventilation less than 72 hours, and 2 needed reintubation due to either myasthenic or cholinergic crises. Nine of the 18 patients achieved complete relief (50%) and 6 of them (33.3%) had their symptoms greatly improved, and the symptoms of one case remained stable (5.6%), and the overall effective rate was 83.3%. CONCLUSION: Video-assisted thoracoscopic thymectomy is a safe and effective method for treatment of myasthenia gravis with satisfactory long-term outcomes.