Sado T
Department of Thoracic Surgery, Tohoku University, Sendai, Japan.
Kyobu Geka. 2010 Jul;63(8 Suppl):731-5.
Extended thymectomy is an effective treatment of myasthenia gravis. In recent years, technological development of endoscopy enables it by thoracoscopic method instead of trans-sternal approach. We perform thoracoscopic extended thymectomy via 4 trocars introduced in bilateral pleural cavity with sternum lifting method through a small incision on epigastric region. The most difficult parts in this procedure are the dissection of the left brachiocephalic vein, especially around the thymic veins and the resection of superior poles of thymus. The rate of perioperative complications by thoracoscopic approach shows no significant differences from the one by the trans-sternal operation. This technique is less invasive than trans-sternal extended thymectomy and it makes the hospital stay after the operation shorter. Since thoracoscopic extended thymectomy is a new technique, the follow-up period of the patients who underwent it for myasthenia gravis is not long enough to evaluate the effectiveness to myasthenia gravis. It is not yet shown whether the long-term results for myasthenia gravis by thoracoscopic extended thymectomy are equal to the ones by trans-sternal technique.
扩大胸腺切除术是治疗重症肌无力的一种有效方法。近年来，内镜技术的发展使得通过胸腔镜方法而非经胸骨入路来实施该手术成为可能。我们通过在双侧胸腔置入4个套管针，并经上腹部小切口采用胸骨上提法来进行胸腔镜扩大胸腺切除术。该手术中最困难的部分是左头臂静脉的解剖，尤其是在胸腺静脉周围，以及胸腺上极的切除。胸腔镜手术的围手术期并发症发生率与经胸骨手术相比无显著差异。该技术比经胸骨扩大胸腺切除术的创伤性小，且术后住院时间更短。由于胸腔镜扩大胸腺切除术是一项新技术，接受该手术治疗重症肌无力的患者随访时间还不够长，不足以评估其对重症肌无力的疗效。胸腔镜扩大胸腺切除术治疗重症肌无力的长期效果是否等同于经胸骨技术的长期效果尚未得到证实。
