Kido Tetsuo
Department of Chest Surgery, Osaka Police Hospital, Osaka, Japan.
Nihon Geka Gakkai Zasshi. 2006 Nov;107(6):273-7.
Fourteen years have passed since video-assisted thoracic thymectomy (VATS-T) began to be used to treat diseases of the thymus. Indications for VATS-T have been expanded by ensuring sufficient space for easy endoscope manipulation using the sternum-lifting method. A variety of VATS-T techniques are available, including the cervical approach, bilateral VATS, infrasternal approach, and others. Although these techniques have the common feature of not involving sternotomy, they differ from each other in terms of the extent of thymectomy. In Japan, bilateral VATS (involving neck incision combined with sternum lifting) or the infrasternal approach (based on the full-directional technique) is often used for extended or maximal thymectomy in myasthenia gravis patients. In a short-term prospective study, VATS-T was shown to be more beneficial than sternotomy in myasthenia gravis patients and those with noninvasive thymoma. With the overall trend toward increased performance of minimally invasive surgery, VATS-T has been more widely adopted as a surgical approach for patients with diseases of the thymus. However, as the number of patients treated with VATS-T has increased, problems specific to endoscopic surgery have become an increasing concern. Whether VATS-T can be considered truly beneficial for patients will depend on the success or failure in solving these problems and the results of long-term prospective studies on the prognosis of patients after treatment with this procedure.
自电视辅助胸腔镜胸腺切除术（VATS-T）开始用于治疗胸腺疾病以来，已经过去了14年。通过使用胸骨上提法确保有足够空间便于内镜操作，VATS-T的适应证得以扩大。VATS-T有多种技术可供选择，包括颈部入路、双侧VATS、胸骨下入路等。尽管这些技术的共同特点是不涉及胸骨切开术，但在胸腺切除范围方面彼此不同。在日本，双侧VATS（包括颈部切口联合胸骨上提）或胸骨下入路（基于全方位技术）常用于重症肌无力患者的扩大或最大程度胸腺切除术。在一项短期前瞻性研究中，VATS-T在重症肌无力患者和非侵袭性胸腺瘤患者中显示出比胸骨切开术更有益。随着微创手术总体执行趋势的增加，VATS-T已被更广泛地用作胸腺疾病患者的手术方法。然而，随着接受VATS-T治疗的患者数量增加，内镜手术特有的问题越来越受到关注。VATS-T是否能被认为对患者真正有益将取决于解决这些问题的成败以及对接受该手术治疗患者预后的长期前瞻性研究结果。
