两孔法全胸腔镜手术治疗胸腺瘤伴重症肌无力9例报告

Two-port video-assisted thoracoscopic surgery for myasthenia gravis: A report of 9 cases

目的 探讨两孔法全胸腔镜手术（VATS）治疗胸腺瘤伴重症肌无力的临床效果。方法 开展两孔法全胸腔镜手术治疗胸腺瘤伴重症肌无力9例。于右侧腋中线第5或第6肋间作1.5～2 cm切口为观察孔兼辅助操作孔,右侧腋前线第3或第4肋间作2～4 cm切口为主操作孔,均切除瘤体与前纵隔脂肪组织。结果 所有手术均在胸腔镜下完成,无中转开胸,未出现重症肌无力危象及其他严重手术并发症,无死亡。9例手术时间90～180 min,平均110 min,术中出血30～250 m L,平均150 m L。术后住院时间7～10 d,平均8.3 d。术后随访7例,随访时间5～14个月,平均10个月,均无复发、转移,重症肌无力症状无明显加重。结论 两孔法全胸腔镜手术治疗胸腺瘤伴重症肌无力安全、可靠、术后并发症少,效果良好。

Objective To explore the clinical efficacy of two-port video-assisted thoracoscopic surgery （VATS） for thymoma complicated with myasthenia gravis （MG）. Methods Nine patients with thymoma complicated with myasthenia gravis underwent two-port video-assisted thoracoscopic surgery. A incision with length of 1.5 to 2 cm was performed at the 5th or 6th intercostal space of right midaxillary line, and was taken as the observation hole and auxiliary operation hole. A incision with length of 2 to 4 cm was performed at the 3th or gth intercostal space of right anterior axillary line, and was taken as the main operating hole. Tumor and anterior mediastinum adipose tissues were resected in all of the cases. Results ALL of the operations were completed under thoracoscope guidance without conversion to open thoracotomy. No myasthenia crisis and other serious complications observed in any cases. No deaths occurred. The mean operative duration was 110 min （range, 90 to 180 min）, the mean introperative blood loss was 150 mL （range, 30 to 250 mL） and the mean hospital stay was 8.3 d （range, 7 to 10 d）. Seven patients were followed up for 7 to 10 d （mean, 8.3d）. During the follow-up, no recurrences, metastasis and aggravation of MG were found in any of cases. Conclusions Two-port video-assisted thoracoscopic surgery is a safe and reliable approach for patients with thymoma complicated with myasthenia gravis. And it has lower incidence rate of complications and shorter recovery time.