胸腔镜与传统正中开胸胸腺扩大切除术治疗重症肌无力的效果比较

The comparison of the efficacy of thymectomy for the treatment of myasthenia gravis- between video-assisted thoracic surgery and thoracotomy

目的比较胸腺扩大切除术与传统正中开胸胸腺扩大切除术治疗重症肌无力(MG)的效果。方法回顾性分析1990年6月至2010年12月收治的173例因MG行手术治疗患者的临床资料。结果胸腔镜组71例,无围术期死亡病例,症状完全消失9例(12.7%),药物治疗减量23例(32.4%),症状部分缓解38例(53.5%),症状无变化或加重1例(1.4%)。正中开胸组102例,无围术期死亡病例,症状完全消失11例(10.8%),药物治疗减量40例(39.2%),症状部分缓解48例(47.1%),症状无变化或加重3例(2.9%)。胸腔镜组和开胸组术后近期缓解率分别为98.6%、97.1%,远期缓解率依次为91.5%、90.2%,差异无统计学意义(P>0.05)。胸腔镜组术后疼痛评分和住院时间低于开胸组[(5.3±2.6)分vs.(6.2±1.7)分,P=0.047;(3±1)d vs.(6±2)d,P=0.021]。结论胸腔镜与正中开胸胸腺扩大切除术手术安全性高,术后患者症状缓解率满意。与正中开胸术式相比,胸腔镜手术具有创伤小、术后住院时间短等优点。

Objective To compare the prognosis of thymectomy by video-assisted thoracoscopy （VATS） or by OPEN thoracotomy and its influence on myasthenia gravis （MG）. Methods Between June 1990 and December 2010, 173 patients were diagnosed with MG and performed with thymectomy in our department, including 71 patients in the VATS group and 102 patients in open thoracotomy group. Results In the VATS group, MG disappeared in 9 （12.6%） cases. Twenty-three （32.4%） cases tapered medication for MG, 38 （54.5%） cases had their MG symptoms alleviated, and 1 case the symptom of MG got worse. In open thoracotomy group, MG disappeared in 11 （10.8%） cases. Forty （39.2%） cases ta-pered medications for MG, 48 （47.1%） cases had their MG symptom alleviated, and for 3 case still had symptoms of MG without improvement. Conclusion VATS thymectomy and thoracotomy can get similar remission rate. But VATS has less trauma and shorter hospital stay. It could serve as a safe alternative for thoracotomy for selected MG patients.