胸腔镜胸腺扩大切除与经胸骨正中劈开行胸腺切除治疗重症肌无力疗效比较

目的：探讨胸腔镜胸腺扩大切除治疗重症肌无力的可行性和临床效果。 方法：回顾性分析2007年9月－2009年9月本院收治的34例经胸腔镜行胸腺扩大切除治疗的重症肌无力患者的临床资料（VATS组），并与2005年11月－2008年5月27例经胸骨正中劈开行胸腺切除治疗的重症肌无力患者（胸骨劈开组，TS组）对比。分析2组患者手术时间、术中出血量、术后应用哌替啶镇痛剂量、术后肌无力危象发生率及术后住院时间等临床资料，并比较2组患者临床症状改善情况。 结果：VATS组34例患者成功完成胸腺切除及前纵隔脂肪清除，全组无手术并发症及死亡病例，术后出现肌无力危象1例（2.94%）。VATS组与TS组比较，术中出血量［(102.64±65.51)mL vs (187.40±68.08)mL］、术后并发症发生率(0.00% vs 11.76%)、术后应用哌替啶镇痛剂量［(19.11±30.19)mg vs (62.96±77.94)mg］及术后住院时间［(9.64±5.53)d vs (13.89±6.75)d］均减少，2组比较差异有显著性（P＜0.05）。VATS组术后随访6～28个月，平均12.7个月，症状改善率84.85%，完全缓解率27.27%，与胸骨劈开组（84.62%，23.08%）比较差异无显著性(P>0.05)。 结论：经胸腔镜行胸腺扩大切除术治疗重症肌无力安全可行、效果良好，并具有创伤小、术中出血少、术后疼痛轻、并发症少、住院时间短以及切口美观等优点。与传统胸骨正中劈开方法比较远期疗效无明显差异。

Comparison of curative effects between video-assisted thoracoscopic extended thymectomy and trans-sternal thymectomy for myasthenia gravis

Objective To discuss the application and effectiveness of video-assisted thoracoscopic(VATS)extended thymectomy for myasthenia gravis(MG).Methods A retrospective review of 34 MG patients who received VATS extended thymectomy from September 2007 to September 2009(VATS group)was undertaken,and compared with 27 MG patients who received trans-sternal(TS)thymectomy from November 2005 to May 2008(TS group).The operation time,blood loss quantity,analgesic pethidine dose,hospitalization time,complication,incidence of MG crisis of the two groups were analyzed and the climical improvement was compared.Results 34 cases of VATS group successfully received thymectomy and anterior mediastinal fat dissection.There were no operative complications and death cases.One case of MG crisis was reported(2.94%).When VATS group was compared with TS group,the blood loss quantity(102.64 mL±65.51 mL vs 187.40 mL±68.08 mL),the probability of postoperative complications(0.00% vs 11.76%),the postoperative analgesic pethidine dose(19.11 mg±30.19 mg vs 62.96 mg±77.94 mg)and the postoperative hospitalization time(9.64 d±5.53 d vs 13.89 d±6.75 d)were decreased,there were significant differences between two groups(P<0.05).The patients in VATS group were followed up 6 to 28 months(mean 12.7 months).Overall clinical improvement at follow-up was observed in 28 of 33(84.85%)patients,with 9 of 33(14.0%)patients in complete stable remission(CSR),compared with TS group(84.64%,23.08%)there was no statistically significant difference(P>0.05).Conclusion VATS extended thymectomy is safe and effective,which is more advantageous for MG patients because of less tissue injury,lighter pain,lower incidence of complication,shorter hospitalization time,better cosmetic result and equivalent CSR rate.