胸腔镜胸腺扩大切除治疗非瘤型重症肌无力

Video-assisted Thoracoscopic Extended Thymectomy for Nonthymomatous Myasthenia Gravis

目的 探讨胸腔镜胸腺扩大切除术（video—assisted thoracoseopic extended thymectomy，VATET）治疗非瘤型重症肌无力的疗效，并分析影响预后的岗素。方法2009年12月～2014年9月我院行胸腔镜胸腺扩大切除术治疗非胸腺瘤型晕症肌无力43例，采用三孔法，胸腔镜下经右胸行胸腺切除及前纵隔脂肪组织廓清术。采用Monden标准评价疗效，分析影响疗效的闲素。结果所有患者均完成VATET，均经右胸行胸腺扩大切除，手术时间75～240min，平均115．4min；术中出血量10～200ml，平均42．2ml，无罔手术期死产。43例随访4～60个月，平均36．2月，缓解12例，改善18例，无变化10例，恶化3例，有效率（缓解＋改善）69．8％（30／43）。多凶素logistie回归分析显示病理类型为胸腺增生是影响非瘤型重症肌无力患者术后疗效的独立危险因素（β=0．921，95％C1：1．866～2．811，P=0．000）。结论VATET治疗非瘤型再症肌无力疗效满意。

Objective To investigate curative effects and prognostic factors of video-assisted thoracoscopie extended thymeetomy （VATET） for nonthymomatous myasthenia gravis （NTMG）. Methods Clinical records of 43 patients with an established diagnosis of NTMG who underwent VATET from December 2009 to September 2014 were reviewed. Three-port thoracoscopic right thymeetomy with resection of fat tissue in anterior mediastinum was conducted. The curative effeets and prognostic factors were evaluated and analyzed with the Monden standard. Results The VATET was successfully completed in all the 4-3 patients. The operation time was 75 - 240Min （ mean, 115.4Min）. The intraoperative blood loss was 10 - 200 ml （ mean, 42.2 ml）. No peri-operative death occurred. Follow-ups for 4- 60 months （mean, 36.2 months） showed 12 cases of remission, 18 cases of improvement, 10 eases of unchanged disease, and 3 cases of deterioration. The effective rate was 69. 8% （30/43）. Multivariate logistic regression analysis showed that pathological type of thymic hyperplasia was the independent risk fae.tor for NTMG postoperatiw outcomes （β = 0. 921,95% CI： 1. 866 - 2.811 , P = 0. 000）. Conclusion Video-assisted thoracoscopie extended thymectomy is effective in most myasthenia gravis patients.