经右胸胸腔镜下全胸腺切除术附38例报道

 目的 探讨胸腔镜下全胸腺切除术的可行性和有效性。方法 回顾分析了2006年8月至2008年11月间38例胸腺疾病和重症肌无力手术患者的临床资料。结果 37例在胸腔镜下行全胸腺切除术，重症肌无力患者行全胸腺及前纵隔脂肪和心包脂肪垫切除术；1例因肿瘤较大，予以小切口辅助行全胸腺切除术。肿瘤最大横径1.5~7 cm；手术时间1.5~2 h；术中出血50~200 mL；术后胸管放置时间为1~3 d；术后住院时间3~18 d，ICU住院时间1~2 d;无围手术期并发症及死亡发生。重症肌无力患者术后无肌无力危象或胆碱能危象发生。全组随访时间为1~27月，失访2例。根据美国重症肌无力协会（MGFA）疗效判断标准，重症肌无力（20例）术后完全缓解6例（6/20），药物缓解8例（8/20），无明显改变5例（5/20），症状加重1例（1/20）。所有患者术后行胸部CT、MRI等检查，未见肿瘤复发。结论 胸腔镜下全胸腺切除术安全可行，具有创伤小、并发症少、效果好等优点，可以成为治疗部分胸腺疾病和重症肌无力的有效手术方法之一。

Video-assisted thoracoscopic extended thymectomy through right thoracic cavity: a report of 38 cases

Objective To discuss the application and effectiveness of video-assisted thoracoscopic extended thymectomy. Methods Clinical data of 38 patients with thymus diseases and myasthenia gravis from August 2006 to November 2008 treated by video-assisted thoracoscopic surgery were reviewed retrospectively. Results Video-assisted thoracoscopic extended thymectomy through right thoracic cavity was performed in 37 patients, and those with myasthenia gravis were received anterior mediastinal fatty tissue and pericardial fat pad dissection. One conversion to thoracotomy was conducted because of the large size of the tumor. The maximal diameter of the tumor was 1.5-7 cm. The operation time was 1.5-2 h. The blood loss was 50 - 200 mL. The time of chest tube placing was 1-3 d. The hospitalization length after surgery was 3-18 d. The period in ICU was 1-2 d. No intra- or post-operative death or complications were reported. No myasthenia gravity crisis or cholinergic crisis occurred among patients with myasthenia gravity. The follow-up period after operation was 1-27 months with the mean of 12 months, and 2 patients withdrew. According to the MGFA post-intervention status classification, among 20 patients with MG, 6 patients were in complete stable remission, 8 patients were in pharmacologic remission, 5 patients were in unchanged and 1 patient was in worse. There was no tumor recurrence in all patients received thoracic CT or MRI examination during the follow-up period. Conclusions Video-assisted thoracoscopic extended thymectomy is safe and effective, which is a superior choice for patients with thymus diseases and myasthenia gravis.