电视胸腔镜胸腺切除治疗重症肌无力症

Video-assisted thoracoscopic thymectomy for myasthenia gravis

目的 探讨电视胸腔镜手术 (video -assistedthoracoscopicsurgery ,VATS)胸腺切除治疗重症肌无力症 (myasthe niagravis ,MG)的可行性。 方法 18例MG采用VATS经右胸前侧径路行胸腺切除联合纵隔脂肪清扫。 结果 17例顺利完成手术 ,1例因电凝钩伤及左头臂静脉干而中转开胸止血。平均手术时间 10 5min ,术中失血量平均 80ml。全组无术后死亡及危象发生。 18例随访 1～ 2 0个月 ,平均 11.3个月。按Osserman疗效评价 ,缓解 5例 (2 7 8% ) ,明显改善 6例(33 3% ) ,部分改善 4例 (2 2 2 % ) ,无变化 3例 (16 7% ) ,有效率 83 3% (15 / 18)。 结论 VATS经右胸前侧径路行完全胸腺切除可行 ,且具有创伤小、恢复快等优点。

Objective To explore the feasibility of video-assisted thoracoscopic thymectomy in the treatment of myasthenia gravis (MG). Methods Eighteen patients with MG underwent thoracoscopic thymectomy along with mediastinal fat cleaning through right anterior lateral approach. Results Of the 18 patients, operations were completed smoothly in 17 patients and a conversion to thoracotomy was required in 1 patient because the left brachiocephalic vein was injured by electric coagulation claw.The mean operative time was 105 min and the mean intraoperative blood loss was 80 ml. There were no post-operative deaths or MG crisis. All the 18 patieuts wre followed for 1～20 months (mean,11.3 months).According to Osserman classification,5 patients (27.8%)showed complete remission,6 patients (33.3%) objective improvement,4 patients (22.2%) partial improvement and 3 patients (16.7%) no change,the total effective rate being 83.3%(15/18). Conclusions Thoracoscopic thymectomy through right anterior lateral approach is technically feasible and has the advantages of minimal invasion and rapid recovery.