双侧胸腔镜扩大胸腺切除治疗非胸腺瘤性重症肌无力

Bilateral Approach Video-assisted Thoracoscopic Extended Thymectomy for Nonthymomatous Myasthenia Gravis

目的探讨双侧胸腔镜辅助扩大胸腺切除(bilateral approach video-assisted thoracoscopic extended thymectomy,BVATET)治疗非胸腺瘤性重症肌无力(nonthymomatous myasthenia gravis,Non-TMG)的可行性及安全性。方法回顾笔者科室2014年1月~2016年3月实施B-VATET的22例Non-TMG资料。根据改良Osserman分型,Ⅰ型6例,Ⅱa型9例,Ⅱb型7例。通过分析B-VATET所用的手术时间(ΔT)、出血量(ΔVb)和切除的胸腺外脂肪组织(ΔWf)等指标对B-VATET的可行性和安全性进行评估。结果全组无手术死亡及术后病情加重患者,平均手术时间120min。较单纯右侧胸腔镜入路扩大胸腺切除手术延长的时间(ΔT)10~50min(平均34.0min)、术中增加的出血量(ΔVb)5~30ml(平均12.5ml)、术中切除的胸腺外脂肪组织(ΔWf)为4.2~60.2g(平均18.6g)。术后病理22例均显示胸腺增生,其中在胸腺外脂肪内查见异位胸腺5例(22.7%)。术后随访3个月~2年,平均随访时间14.3个月。完全稳定缓解率72.7%(16/22)。结论研究结果推荐采用B-VATET术式治疗Non-TMG患者。但有待于对该组病历的进行长期随访评估和更广泛的数据加以验证。

Objective To explore the feasibility and safety of bilateral approach video - assisted thoracoscopic extended thymectomy （ B - VATET） for treatment of non - thymomatous myasthenia gravis （ Non - TMG）. Methods Twenty - two cases of Non - TMG patients underwent B - VATET in our hospital were involved from 2014 January to 2016 March. Including 5 males and 16 females. Aged 21 to 57 years. According to the modified Osserman Classification, 6 eases were I type, 9 cases were Ⅱa type, and7 cases were Ⅱb type. The extended operation time （AT）, increased blood loss （AVb） and the weight of fatty tissue resected （AWl） were evaluate to assess the fea- sibility and safety of B - VATET. Results There was no operative mortality,no recurrence was found at 14.3 months of follow - up. The Total operation time of B -VATET averaged 120rain. The extended operation time （AT） , increased blood loss （AVb） and the weight of fatty tissue resected （AWl） was 10 - 50min（ average 34.0min） ,5 - 30ml（ average 12.5ml） and 4.2 - 60.2g（ average 18.6g） respective- ly. Postoperative pathological results showed thymic hyperplasia in 22 cases, eetopie thymie tissue was detected in 5 cases （22.7%）. Pa- tients were followed up in （average）. After 14.3 months follow - up （ 3 months - 2 years）, the rate of complete stable remission （CSR） was 72.7%. Conclusion These results support the recommendation for B - VATET in the treatment of patients with Non - TMG. Long - term follow- up assessment and more extensive data are mandatory to verify the early surgical outcomes.