胸腔镜入路和胸骨正中入路胸腺扩大切除术治疗胸腺瘤合并重症肌无力的疗效比较

Comparison of Curative Effects between Video-assisted Thracoscopic Extended Thymectomy and Trans-sternal Extended Thymectomy for Thymoma with Myasthenia Gravis

目的通过比较胸腔镜入路和胸骨正中入路胸腺扩大切除术治疗胸腺瘤并重症肌无力(MG),探讨胸腔镜胸腺扩大切除术的临床应用价值。方法回顾性分析2006年5月～2011年9月笔者医院收治的50例胸腺瘤并MG患者的临床资料,并分为2组,其中,行电视胸腔镜(video-assisted thoracic surgery,VATS)VATS胸腺扩大切除术22例,行胸骨正中入路胸腺扩大切除术28例,2组患者均切除胸腺和清扫前纵隔脂肪组织。结果VATS组无围术期肌无力危象发生,胸骨劈开组中2例发生围术期肌无力危象,2组患者均无围手术期死亡。VATS组术中出血量、术后胸腔引流时间、术后住院时间、ICU监护时间均较开胸组减少,2组比较差异有统计学意义(P<0.05或P<0.01);2组手术时间比较差异无显著性(P>0.05)。结论电视胸腔镜胸腺扩大切除术治疗胸腺瘤并MG技术上是可行的,且具有创伤小、恢复快、并发症少等优势。

Objective To investigate the value of video-assisted thracoscopic surgery（VATS） in the treatment of thymoma with myasthenia gravis（MG） by comparing with trans-sternal（TS） extended thymectomy.Methods A retrospective review of 50 thymoma with MG patients from May 2006 to September 2011,22 cases were treated by VATS extended thymectomy,28 cases were treated by transsternal extended thymectomy.Results No patient had myasthenia crisis in VATS group,but 2 patients developed myasthenia crisis in TS group.There was no mortality in the two groups.When VATS group was compared with TS group,the blood loss during operation,the time of postoperative drainage tube left in chest,postoperative hospitalization days and length of stay in ICU were decreased,and there were significant differences between two groups（P0.01 or P0.05）,but the operative time between two groups was no significant difference（P0.05）.Conclusion Video-assisted thoracoscopic extended thymectomy is feasible for thymoma with MG,the operation was showed as smaller traumas,rapid recovery and less complication.