Tan Qun-you, Wang Ru-wen, Jiang Yao-guang, Deng Bo, Ma Zheng, Gong Tai-qian, Zhou Jing-hai, Zhao Yun-ping
Department of Thoracic Surgery, Daping Hospital & Research Institute of Surgery, the Third Military Medical University, Chongqing 400042, China.
Zhonghua Wai Ke Za Zhi. 2008 Mar 15;46(6):408-10.
To evaluate the feasibility and curative effect of thymectomy for myasthenia gravis (MG) by video-assisted thoracoscopic surgery (VATS) through right anterior-lateral approach.
Fifty-six patients of MG were treated with thoracoscopic thymectomy and mediastinal fat dissection through right anterior-lateral approach from August 2001 to October 2007. The feasibility, safety, complication and remission for MG were retrospectively analyzed.
Fifty-five operations were completed by VATS. The mean operative time and blood loss were (96.2 +/- 52.1) min and (68.7 +/- 21.4) ml, respectively. The brachiocephalic vein injury by the electric coagulator occurred in two cases and one of them performed thoracotomy for homeostasis, the other performed ligation. The postoperative pathology showed hyperplasia in 38 cases, atrophy in 5 cases, thymoma in 12 cases and cyst of thymus in 1 case. And the operative complication included one myasthenia crisis (1.8%) at the third day and one death (1.8%) at the eighth day because of postoperative hemorrhage. The average length of stay was (7.9 +/- 2.9) d. All cases were followed up from one to seventy months. Eight (14.3%) of complete remission, 39 cases (69.6%) of partial remission and 7 cases (12.5%) of no change were found. The total effective rate was 83.9%.
Thoracoscopic thymectomy through right anterior lateral approach is technically feasible, safe and minimally invasive. It has a high remission rate for MG.
通过右前外侧入路电视辅助胸腔镜手术（VATS）评估重症肌无力（MG）胸腺切除术的可行性及疗效。
回顾性分析2001年8月至2007年10月采用右前外侧入路胸腔镜胸腺切除术及纵隔脂肪清扫术治疗的56例MG患者。分析手术的可行性、安全性、并发症及MG缓解情况。
55例手术通过VATS完成。平均手术时间和失血量分别为（96.2±52.1）分钟和（68.7±21.4）毫升。电凝器损伤头臂静脉2例，其中1例开胸止血，另1例结扎。术后病理显示增生38例，萎缩5例，胸腺瘤12例，胸腺囊肿1例。手术并发症包括术后第3天1例肌无力危象（1.8%），术后第8天1例因术后出血死亡（1.8%）。平均住院时间为（7.9±2.9）天。所有病例随访1至70个月。完全缓解8例（14.3%），部分缓解39例（69.6%），无变化7例（12.5%）。总有效率为83.9%。
右前外侧入路胸腔镜胸腺切除术技术上可行、安全且微创。对MG有较高的缓解率。
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