Tomulescu V, Ion Virginia, Kosa A, Popescu I
Centrul de Chirurgie Generală si Transplant Hepatic, Institutul Clinic Fundeni.
Chirurgia (Bucur). 2005 May-Jun;100(3):215-22.
A series of 151 thoracoscopic thymectomy performed in the Department of General Surgery and Liver Transplantation of the Fundeni Clinical Institute between April 1999 and April 2004 is analyzed. These were 89.34% from all the thymectomies performed in our department in this period. Thoracoscopic thymectomies were performed on 131 female patients (86.75%) and 20 male patients (23.25%), aged between 8 and 60 years. All patients were previously treated in the Neurological Department of the Fundeni Clinical Institute for at least 3 months. The thoracoscopic thymectomy was indicated for: myasthenia gravis without thymic neoplasia (141 cases), stage I Masaoka thymoma (8 cases), remnant postoperative thymic tissue (3 cases). We have used a left thoracoscopic approach in 73 cases and a right thoracoscopic approach in 76 cases. In 2 cases a mixed cervical and thoracoscopic approach was needed.. No mortality and morbidity 6.62% (10 cases). From this 151 patients 100 have been constantly followed for more then one year. From the other 51, 32 are in the first postoperative year, and the other 19, 12.58% have been lost in surveillance. The one year evaluation regarding the Research Standards of Myasthenia Gravis Task Force Foundation shows: improvement--90% (complete stable remission--14%; pharmacological remission--20%; minimal manifestation--56%), unchanged--8%, worsened--2%. Our results with a complete stable remission of 14% at the end of the first year and 50% at 5 years are at least comparable with literature results with other open or thoracoscopic approaches.
对1999年4月至2004年4月期间在Fundeni临床研究所普通外科和肝移植科进行的151例胸腔镜下胸腺切除术进行了分析。这些手术占同期我院所有胸腺切除术的89.34%。接受胸腔镜下胸腺切除术的患者有131名女性（86.75%）和20名男性（23.25%），年龄在8岁至60岁之间。所有患者此前均在Fundeni临床研究所神经科接受了至少3个月的治疗。胸腔镜下胸腺切除术的适应症为：无胸腺肿瘤的重症肌无力（141例）、I期Masaoka胸腺瘤（8例）、术后残留胸腺组织（3例）。我们采用左胸腔镜入路73例，右胸腔镜入路76例。2例需要采用颈胸联合入路。无死亡病例，并发症发生率为6.62%（10例）。这151例患者中，100例得到了持续一年以上的随访。另外51例中，32例处于术后第一年，另外19例（12.58%）失访。根据重症肌无力任务组基金会的研究标准进行的一年评估显示：改善——90%（完全稳定缓解——14%；药物缓解——20%；轻度表现——56%），不变——8%，恶化——2%。我们的结果显示，第一年结束时完全稳定缓解率为14%，5年时为50%，至少与其他开放或胸腔镜手术方法的文献结果相当。
