电视胸腔镜胸腺扩大切除治疗重症肌无力131例分析

Experience in video-assisted thoracoscopic extended thymectomy for 131 cases with myasthenia gravis

目的评价电视胸腔镜胸腺扩大切除治疗重症肌无力的手术方法、安全性、技术要点和疗效。方法重症肌无力患者131例中，Ⅰ型31例，Ⅱa型43例，Ⅱb型42例，Ⅲ型14例，Ⅳ型1例，在全身麻醉下经右胸人路行胸腔镜下胸腺扩大切除术，术中打开前上纵隔胸膜，暴露胸腺组织，用锐性和钝性方法游离完整切除胸腺左右叶及心包前脂肪，评估术后疗效。结果所有患者手术顺利，手术时间30—270min，平均（89±31）min；术中出血量20—400ml，平均（53±21）ml；术后住院时间为4～12d，平均（7．3±2．3）d。术后并发重症肌无力危象1l例（8．4％），并发肺炎19例（14．5％），无死亡病例。术后病理：单纯胸腺增生99例，合并胸腺瘤31例，恶性胸腺瘤1例。术后随访109例，随访时间12～72个月，平均（38±20）个月，失访12例（9．2％）。完全缓解51例（46．8％）、部分缓解47例（43．1％）、稳定8例（7．3％）、恶化3例（2．8％），总缓解率89．9％。结论电视胸腔镜胸腺扩大切除术是目前治疗重症肌无力的有效术式，具有微创、安全、疗效确切、手术时间短、术后恢复快、并发症少等优点。

Objective To evaluate the surgical methods, security, technical points and efficacy of video-assisted thoracoscopic extended thymeetomy for myasthenia gravis. Methods There were 131 cases of myasthenia gravis （MG）, 31 cases of type Ⅰ , 43 cases of type Ⅱa, 42 eases of type Ⅱb, 14 cases of type Ⅲ and 1 ease of type Ⅳ. All patients underwent video-assisted thoracoscopic extended thymectomy under general anesthesia through the right chest approach. We opened the front upper mediastinal pleura to expose thymus tissue and did complete removal of the thymus and pericardial fat by sharp and blunt method. The curative effect was evaluated. Results The operation time ranged from 30 to 270 min （89 ±31 min） ; intraoperative blood loss ranged from 20 to 400 ml （53 ± 21 ml） and postoperative hospital stay ranged from 4 to 12 d（7.3 ±2.3 d）. Postoperative myasthenia gTavis crisis occurred in 11 cases （8.4%） and pneumonia occurred in 19 cases （14.5%）. There was no postoperative mortality. Pathology ：99 cases had simple thymic hyperplasia; 31 cases had thymoma and 1 case had malignant thymoma. Postoperative follow-up was done with 109 cases and the follow-up time ranged from 12 to 72 months （ 38 ± 20 months）. 12 patients （9.2%） failed to be followed up. 51 cases achieved complete remission（46.8% ）. 47 cases achieved partial remission（43.1% ）. 8 cases were stable（7.3% ）. 3 cases deteriorated（2.8% ） ; the total remission rate was 89.9%. Conclusions Video-assisted thoracoscopic thymus extended resection is an effective technique for the treatment of myasthenia gravis, which avoids the trauma brought by traditional thoracotomy and is considered to be minimally invasive, safe and efficient with a short operative time and rapid postoperative recovery.