Agasthian Thirugnanam, Lin Soon Jia
National Cancer Center, 11 Hospital Drive, Singapore.
Asian Cardiovasc Thorac Ann. 2010 Jun;18(3):234-9. doi: 10.1177/0218492310369017.
We reviewed our experience of video-assisted thoracoscopic thymectomy for myasthenia gravis and thymomas in 119 patients, aged 12-83 years, who were treated between 1998 and 2007. Disease severity was graded using the Osserman classification. To prevent rupture of the tumor capsule and tumor seeding, thymomas were resected using a modified no-touch technique. Thymoma diameters were 10-90 mm (mean, 50 mm). There were no operative deaths, 12 (10%) patients had complications, and 87 (73.1%) improved by 1 or more Osserman grades postoperatively. After follow-up of 1.9-10 years (mean, 4.9 years), 74 (62%) patients remained asymptomatic, with 21% in complete stable remission. Using multivariate regression analysis, there were no statistical differences in median pre- and postoperative Osserman grades with regards to age, sex, duration of symptoms, and presence of thymoma. Video-assisted thoracoscopic thymectomy for myasthenia gravis and selected thymomas can achieve long-term clinical outcomes comparable to those of standard approaches.
我们回顾了1998年至2007年间对119例年龄在12至83岁之间的重症肌无力和胸腺瘤患者进行电视辅助胸腔镜胸腺切除术的经验。疾病严重程度采用奥斯默曼（Osserman）分类法分级。为防止肿瘤包膜破裂和肿瘤播散，采用改良的非接触技术切除胸腺瘤。胸腺瘤直径为10至90毫米（平均50毫米）。无手术死亡病例，12例（10%）患者出现并发症，87例（73.1%）患者术后奥斯默曼分级改善1级或更多。经过1.9至10年（平均4.9年）的随访，74例（62%）患者无症状，21%处于完全稳定缓解状态。采用多因素回归分析，在年龄、性别、症状持续时间和胸腺瘤存在情况方面，术前和术后奥斯默曼分级中位数无统计学差异。电视辅助胸腔镜胸腺切除术治疗重症肌无力和特定胸腺瘤可取得与标准手术方法相当的长期临床效果。
