基层医院胸腔镜胸腺扩大切除治疗重症肌无力的临床应用

Application of video-assisted thoracoscopic surgery and transsternal thymectomy for treatment of myasthenia gravis in primary hospital

目的探讨基层医院采用胸腔镜胸腺扩大切除术（VATS）治疗重症肌无力（MG）的可行性。方法回顾分析我院采用胸腺扩大切除术治疗的重症肌无力（非胸腺瘤）患者68例，其中胸腔镜手术34例，胸骨劈开术34例，术后随访1～6年。结果VATs组患者均在胸腔镜下完成，手术时间（90．1±15．0）min，出血（45．0±5．5）mL，胸腔引流（2．5±1．2）d，术后住院时间（7．0±1．2）d，无严重并发症，无手术死亡。胸骨劈开组手术时间（98．0±12．5）min，出血（118．5±17．5）mL，胸腔引流（4．5±1．3）d，术后住院日（11．0±2．5）d，肌无力危象2例。2组患者中远期疗效差异无统计学意义。结论胸腔镜下胸腺扩大切除治疗MG，较胸骨劈开胸腺扩大切除治疗MG更具优势，具有并发症少、疗效可靠等优点，值得基层医院推广应用。

Objective To identify the availability of video-assisted thoracoscopic thymectomy. Methods Retrospectively analyzed 68 patients with myasthenia gravis who underwent thymectomy including 34 cases of video-assisted thoraeoseopic thymectomy and 34 cases of transsternal thymectomy, and the patients were followed up for 1 - 6 years. Results Patients of the VATS group were given video-assisted thoracoseopie thymectomy. The mean operative time was （90.1± 15.0） rain, mean blood loss was （45.0 ± 5.5 ） mL, mean chest tube drain- age time was （2.5 ± 1.2） days and mean postoperative hospital stay was （7.0 ± 1.2） days in VATS group,and there was no serious compli- cations and surgical death. The mean operative time was （98.0 ±12.5 ） min, mean blood loss was （ 118.5 ± 17.5 ） mL, mean chest tube drainage time was （4.5 ±1.3 ） days and mean postoperative hospital stay was （11.0 ± 2.5） days in transsternal thymectomy group. 3 pa- tients developed MG crisis. There was no significant difference in mid-and long-term effects between the two groups（P 〉 0.05 ）. Conclusion Video-assisted thoracoscopic thymectomy for MG is safe and feasible with the advantage of less invasion, less surgical trauma, lower rate of complication, and good curative effect compared with transsternal thymectomy.