重症肌无力电视胸腔镜与胸骨部分劈开行胸腺扩大切除比较

目的 探讨电视胸腔镜手术(VATS)在重症肌无力(MG)治疗中的价值.方法 应用随机对照研究前瞻性分析2005年至2008年开展的VATS和胸骨部分劈开行胸腺切除治疗MG疗效,比较两组在手术时间、术中出血量、术后胸管放置时间、术后住院时间、术后发生重症肌无力危象及疗效等方面差异.结果 VATS组中26例手术顺利,1例因电凝钩伤及头臂静脉中转开胸.与部分胸骨劈开组比较,VATS组术中出血少、手术时间短、术后放置胸管时间及术后住院时间缩短.VATS组与胸骨劈开组比较发生肌无力危象0例对3例,肺部感染2例对9例,胸骨上窝或伤口感染0例对3例.随访6～24个月,VATS和胸骨劈开组有效率分别为81%(21/26例)和85%(23/27例),差异无统计学意义.结论 VATS下胸腺扩大切除治疗重症肌无力,技术是安全、可行的,具有创伤小、痛苦轻、并发症少、疗效可靠等优点,临床应用前景良好.

Comparision study of video-assisted thoracoscopic and partial sternotomy extended thymectomy for myasthenia gravis

Objective Explore the value of video-assisted thoracoscopic extended thymectomy in the treatment of myasthenia gravis.Methods This is a prospective randomized control study.Fifty-four patients who were confirmed to be MG preoperatively from 2005 to 2008 were divided into VATS group(27 cases)and thoracotomy group(27cases).Thymectomy and dissection of all faity tissue anterior to pericardium were performed in both groups.Results When compared with thoacotomy group,VATS group had less blood loss,shorter postoperative hospital stay and time of postoperative chest drainge tube left.One patient was converted to open surgery because of the injury to the brachiocephalic vein.During a period of followed-up 624 months,symptom was improved in 81% of the patients in VATS group and 85% in thoractomy group(P>0.05).Conclusion Extened thymectomy with VATS is safe and feasible with the advantage of less invasion,less surgical trauma and pain,lower rate of complication and good curative effect.