胸腺瘤合并重症肌无力全胸腔镜下手术治疗临床疗效分析

Technical points on video assisted thoracoscopic thymectomy for thymoma accompanied by myasthenia gravis

目的探讨胸腔镜微创治疗胸腺瘤合并重症肌无力的可行性和治疗效果。方法收集2008年1月至2012年12月胸腺瘤合并重症肌无力患者42例，全部采用胸腔镜微创技术施行胸腺扩大切除术。其中I型23例，Ⅱa型11例，Ⅱb型7例，Ⅲ型1例。随访观察胸腺瘤及重症肌无力术后转归及复发情况，并对患者年龄、性别、病理类型以及重症肌无力严重程度等因素进行分析。结果所有手术均顺利完成，无中转开胸及手术死亡病例，所有患者术后恢复良好出院，完全缓解率64．3％，总有效率85．7％。结论胸腔镜下行胸腺扩大切除术治疗重症肌无力的技术是安全可行的，疗效确切，且有术后并发症少、恢复快等优点。

Objective To explore the value of video-assisted thoracoscopic thymectomy in the treatment of thymoma accompanied by myasthenia gravis. Methods In this study, forty-two patients who were preoperatively con- firmed to be thymoma accompanied by myasthenia gravis from 2008.1 to 2012.12 were treated using VATS,including type Ⅰ in 23 cases, type Ⅱ a in 11 cases, type Ⅱ b in 7 cases, and type Ⅲ in 1 case. Thymectomy and dissection of all fatty tissue anterior to the pericardium were performed in all cases. The operation time, blood loss, chest drainage time,hospital stay and outcomes were recorded and compared. Results In this group, one patient showed myasthenic crisis after surgery and recovery well after treated by ventilatory support, the patients had fewer blood loss（ 〈 35mL）, shorter operation and postoperative drainage time, and shorter postoperative hospital stay. Conclusion Extended thymectomy by VATS is safe and feasible w/th the advantage of less invasion, less surgical trauma and pain,lower rate of complication, and good curative effect.