VATS胸腺扩大切除术治疗重症肌无力临床分析

目的评价电视胸腔镜(video-assistant thorascope,VATS)下胸腺扩大切除术治疗重症肌无力(myasthenia gravis,MG)的手术方法和效果。方法回顾性分析36例MG患者的临床资料,其中合并胸腺增生26例,胸腺瘤10例,均行VATS胸腺瘤、胸腺扩大切除术。根据临床Osserman分型:Ⅰ型3例,Ⅱa型22例,Ⅱb型8例,Ⅲ型3例。结果本组手术全部经胸腔镜完成,无中转开胸者。全组手术时间平均80(50~120)min,术中出血量平均80(10~150)ml,留置胸腔引流管1~3 d,引流量平均150(100~500)ml,6例未留置胸管者术后3 d经CT扫描估计胸液量均<200 ml。住院时间3~6 d,术后未出现进行性血胸,无肺及膈神经损伤,无肌无力危象、胆碱能危象发生,无围手术期死亡病例。术后病理:胸腺增生26例,A型胸腺瘤6例,B1型2例,B3型2例(WHO分型)。所有患者随访3~12个月,完全缓解6例(Ⅰ型2例、Ⅱa型4例),占16.7%;部分缓解28例(Ⅰ型1例、Ⅱa型18例、Ⅱb型7例、Ⅲ型2例),占77.8%;稳定2例(Ⅱb型1例、Ⅲ型1例),占5.6%。结论 MG患者行VATS胸腺瘤、胸腺扩大切除术安全、可行,效果理想。

Clinical Analysis on Video-assistant Thoracoscopic Extended Thymectomy for Myasthenia Gravis

Objective To evaluate the surgical approach and effect of video-assisted thoracoscopic （VATS） extended thymectomy for myasthenia gravis （MG）. Methods The clinical data of 36 MG patients combined thymoma （10 cases） or thymus hyperplasia （26 cases） were reviewed. All cases were treated by VATS extended thymectomy. According to Osserman classification, 3 cases were type Ⅰ , 22 cases were type Ⅱ a, 8 cases were type Ⅱb and 3 cases were type Ⅲ. Results All cases were accomplished the VATS ex- tended thymectomy without thoracotomy. The operative duration was 50 to 120 minutes （mean 80）, and the intra- operative blood loss was 10 to 150 ml （mean 80）. The duration of chest tube drainage was 1 to 3 days and the drainage volume was 100 to 500 ml with an average of 150 ml. The hospital stay after surgery was 3 to 6 days. No perioperative death or complications such as progressive hemothorax, injuries of lung and phrenic nerve, myas- thenic crisis and cholinergic crisis were reported. The pathologic exam showed 26 of thymus hyperplasia, 6 of thy- moma with type A, 2 with B1 and 2 with B2 according to WHO classification. All cases were followed up for 3 to 12 months. The results revealed complete remission in 6 cases （including 2 of type Ⅰ and 4 of type Ⅱa）, partial remission in 28 cases（including 1 of type Ⅰ, 18 of type Ⅱ a, 7 of type Ⅱb and 2 of type Ⅲ）, and Stabilization in 2 cases （ including 1 of type Ⅱ b and 1 of type Ⅲ） Conclusion Extended thymectomy by VATS is a safe and effective surgery, and therefore it is a preferred choice for MG panents.