胸腔镜扩大切除胸腺及胸腺瘤治疗重症肌无力

Thoracoscopic maximal thymectomy for the treatment of myasthenia gravis

目的：探讨胸腔镜扩大切除胸腺和胸腺瘤治疗重症肌无力的可行性和疗效。方法：回顾性分析2003年7月至2010年12月北京大学深圳医院收治的45例重症肌无力患者的临床资料．均行电视胸腔镜（VATS）下经右胸前侧径路胸腺及胸腺瘤扩大切除术，切除范围包括胸腺瘤在内全胸腺组织到前纵隔和上纵隔所有脂肪组织。结果：45例患者中顺利完成手术44例，1例因术中左无名静脉损伤出血．转为开胸手术；无死亡病例；平均手术时间102rain、平均胸腔引流时间2d、术后平均住院时间5d。术后随访3～24个月，总有效率为77．7％（35／45），其中稳定缓解18例、药物缓解17例、无效10例。结论：经右胸前侧径路胸腔镜下胸腺及胸腺瘤扩大切除治疗重症肌无力在技术上可行，具有创伤小、疼痛轻、并发症少、住院时间短、恢复快等优点，但期远期疗效尚待长期随访观察。

Objective： To study the feasibility and efficacy of maximal thymectomy via video-assisted thoraeoscopic surgery （ VATS ） for the treatment of myasthenia gravis （ MG ）. Methods： We retrospectively analyzed the clinical profiles of 45 patients who underwent maximal thymectomy by following the right lateral thoracic path via VATS, for resection of the thymus and all adipose tissues of the anterior and upper mediastinum, in the Affiliated Shenzhen Hospital of Peking University between July 2003 and December 2010. Results： Of 45 patients who underwent maximal thymectomy, 44 successfully completed with exception of a single case transferred to open-thorax surgery owing to the left venae anonyma injury leading to hemorrhage. No death tool was reported. The mean duration was 102 minutes for maximal thymectomy, 2 days for thoracic drainage and 5 days for the hospital stay. A total effective rate of 77.7% （ 35/45 ） was yielded for a follow-up period of 3 to 24 months, based on 18 cases who presented stabilized amelioration, 17 drug-assisted amelioration and 10 treatment failure. Conclusion： Characterized by high safety, minor sense of pain, reduced incidence of complication, shortened hospital stay and prompt recovery, maximal thymectomy by following the right lateral thoracic path via VATS may be technically feasible for the treatment of myasthenia gravis yet deserves further follow-up study to investigate the long-term efficacy.