关键词: 电视胸腔镜手术； , 胸腺扩大切除； , 重症肌无力

Abstract:

Abstract:Objective To discuss the application and effectiveness of video-assisted thoracoscopic (VATS) extended thymectomy for myasthenia gravis (MG).  Methods A retrospective review of 34 MG patients who received VATS extended thymectomy from September 2007 to September 2009 (VATS group) was undertaken,and compared with 27 MG patients who received trans-sternal (TS) thymectomy from November 2005 to May 2008(TS group). The operation time,blood loss quantity,analgesic pethidine dose,hospitalization time,complication,incidence of MG crisis   of the two groups were analyzed and the climical improvement was compared.  Results 34 cases of VATS group successfully received thymectomy and anterior mediastinal fat dissection. There were no operative complications and death cases. One case of MG crisis was reported (2.94%). When VATS group was compared with TS group,the blood loss quantity(102.64 mL±65.51 mL vs 187.40 mL±68.08 mL),the probability of postoperative complications (0.00% vs 11.76%),the postoperative analgesic pethidine dose (19.11 mg±30.19 mg vs 62.96 mg±77.94 mg) and the postoperative hospitalization time (9.64 d±5.53 d vs 13.89　d±6.75　d) were decreased,there were significant differences between two groups(P<0.05). The patients in VATS group were followed up 6 to 28 months(mean 12.7 months). Overall clinical improvement at follow-up was observed in 28 of 33 (84.85%) patients,with 9 of 33 (14.0%) patients in complete stable remission(CSR),compared with TS group(84.64%,23.08%) there was no statistically significant difference(P>0.05). Conclusion VATS extended thymectomy is safe and effective,which is more advantageous for MG patients because of less tissue injury,lighter pain,lower incidence of complication, shorter hospitalization time,better cosmetic result and equ
ivalent CSR rate.

Key words: video-assisted thoracoscopic surgery, extended thymectomy, myasthenia gravis