Zhang Yun-feng, Ma Shan, Li Jian-ye, Yu Lei, Zhang Hai-feng
Department of Thoracic Surgery, Beijing Tongren Hospital, Capital University of Medical Sciences, Beijing 100730, China.
Zhonghua Wai Ke Za Zhi. 2009 Mar 1;47(5):366-8.
To investigate different characteristics of the video-assisted thoracoscopic (VATS) versus transsternal thymectomy for myasthenia gravis (MG).
The clinical data of 106 patients who underwent VATS thymectomy for MG between February 2002 and May 2007, and 108 patients who underwent transsternal thymectomy between March 1998 and August 2003 were analyzed retrospectively. In VATS group, there were 64 male and 42 female patients, and the mean age was 38-years-old. In the transsternal group, 68 patients were male and 40 were female, and the mean age was 36-years-old. Analysis of conditions related to the surgical procedure between two groups was made, such as length of surgery, operative bleeding, postoperative drainage, hospital stay, hospitalization expenses and complications. The mean time of follow-up was 38.5 months (ranging from 10 to 67 months). All patients were classified according to the MGFA clinical classification.
Intraoperative bleeding in VATS group was (34 +/- 5) ml, significantly less than (150 +/- 23) ml in the transsternal group. Postoperative drainage in VATS group was (42 +/- 18) ml, significantly less than (168 +/- 31) ml in the transsternal group. Complications and hospital stay in VATS group were also significantly lower than those in the transsternal group. There was no significantly different in the long-term outcome between two groups.
Although both thoracoscopic and transsternal approaches to thymectomy in patients with MG are effective after the long-term follow-up, VATS thymectomy has its specific advantages of minimal invasion, less complications, and rapid recovery.
探讨电视辅助胸腔镜手术（VATS）与经胸骨胸腺切除术治疗重症肌无力（MG）的不同特点。
回顾性分析2002年2月至2007年5月间106例行VATS胸腺切除术治疗MG患者及1998年3月至2003年8月间108例行经胸骨胸腺切除术患者的临床资料。VATS组中，男性64例，女性42例，平均年龄38岁。经胸骨组中，男性68例，女性40例，平均年龄36岁。对两组间与手术相关的情况进行分析，如手术时间、术中出血、术后引流、住院时间、住院费用及并发症。平均随访时间为38.5个月（10至67个月）。所有患者均根据MGFA临床分类进行分类。
VATS组术中出血量为（34±5）ml，明显少于经胸骨组的（150±23）ml。VATS组术后引流量为（42±18）ml，明显少于经胸骨组的（168±31）ml。VATS组的并发症及住院时间也明显低于经胸骨组。两组的长期疗效无明显差异。
虽然MG患者行胸腔镜和经胸骨胸腺切除术长期随访后均有效，但VATS胸腺切除术具有创伤小、并发症少及恢复快等独特优势。
