电视胸腔镜与胸骨部分劈开胸腺切除治疗重症肌无力症的比较

目的 探讨经右胸电视胸腔镜手术(VATS)与胸骨部分劈开胸腺切除治疗重症肌无力的优缺点.方法 2001年8月至2006年9月我科32例重症肌无力患者用VATS经右胸前侧径路行胸腺切除及纵隔脂肪清除(VATS组),并与40例胸骨劈开胸腺切除(胸骨部分劈开组)比较.结果 VATS组中31例顺利完成手术,1例因电凝钩伤及头臂静脉干而中转开胸止血,术后无1例发生肌无力危象,亦无手术死亡.胸骨部分劈开组术后5例发生肌无力危象,呼吸机支持后恢复,1例术后2 d因急性心肌梗死死亡.与胸骨劈开组相比,VATS组手术时间和住院时间均明显缩短,危象的发生率显著降低.两组术后MGFA 评分和溴化吡啶斯的明用量均较术前明显下降(P＜0.01, P＜0.05).结论 VATS经右胸前外侧径路行胸腺切除安全、可行,与胸骨部分劈开径路相比具有创伤小、并发症少、恢复快等优点.

Thymectomy via video-assisted thoracoscopy and partial sternotomy approach for myasthenia gravis

Objective To study the outcome of surgical treatment of myasthenia gravis(MG)by thymectomy via video-assisted thoracoscopic surgery(VATS)and partial sternotomy.Methods Thirty-two cases of MG were treated by thoracoscopic thymectomy along with mediastinal fat cleaning via right anterior-lateral approach(VATS group)and 40 cases were treated by by transsternal thymectomy via partial sternotomy(transsternal group)from April 2001 to September 2006.Results In VATS group,thoracoscopic thymectomy was performed successfully in 31 cases and additional thoracotomy was employed in 1 patient because of the injury of the left anonymous vein by electric coagulation claw during VATS.There was no postoperative mortality or MG crisis.In transsternal group,1 patient died 2 days after operation because of acute cardiac infarction,5 cases of MG crisis occurred postoperatively and all recovered after respiratory support.Compared with transsternal group,the operation time and hospital days were both shorter in VATS group.The postoperative dose of mestinon bromid and MGFA scores were both decreased in the two groups(VATS group P<0.01,transsternal group P<0.05).Conclusion Thymectomy by VATS via right anterior-lateral approach is technically feasible and safe.Compared with the transsternal thymectomy via partial sternotomy,it still has advantages of minimal invasion,less complications and rapid recovery.