Chen Zhenguang, Zuo Jidong, Zou Jianyong, Sun Yanhong, Liu Weibing, Lai Yingrong, Zhong Beilong, Su Chunhua, Tan Min, Luo Honghe
Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Eur J Cardiothorac Surg. 2014 Apr;45(4):646-51. doi: 10.1093/ejcts/ezt443. Epub 2013 Sep 4.
Myasthenia gravis (MG) is a common chronic disorder of neuromuscular transmission, frequently treated surgically. Little is known about perioperative cellular immune responses following video-assisted thoracoscopic surgery (VATS) when compared with open resection.
Between January and December 2009, 127 patients with non-thymomatous MG underwent surgery, with 54 undergoing VATS and 73 undergoing conventional trans-sternal extended thymectomy (TS). Operative details, ectopic thymic tissue findings, postoperative concentrations of serum immunoglobulin and complement components as well as T-cell immunity were compared in the VATS and TS groups.
There were no between-group differences in patients' age, gender, preoperative duration of MG and operation time. Patients who underwent VATS had a lower rate of postoperative stay in the intensive care unit (P = 0.02), less blood loss (P = 0.01) and a lower probability of ectopic thymic tissue. Prominent cellular immunity difference occurred in serum IgG and C3 concentrations and CD4(+) and CD8(+) T-cell counts between the VATS and TS groups. In VATS patients, serum IgG concentration increased slightly on postoperative days 1 and 3. C3 concentration increased gradually in both groups after surgery, but decreased by postoperative day 7. CD4(+) and CD8(+) T-cell counts were relatively stable postoperatively in the VATS group, but were markedly increased in the TS group on postoperative days 1 and 3, with CD4(+), but not CD8(+), T-cells declining on postoperative day 7.
VATS for non-thymomatous MG has short-term advantages, with less effect on cellular immune responses than open resection.
重症肌无力（MG）是一种常见的神经肌肉传递慢性疾病，常采用手术治疗。与开放性切除术相比，电视辅助胸腔镜手术（VATS）围手术期细胞免疫反应鲜为人知。
2009年1月至12月期间，127例非胸腺瘤性MG患者接受了手术，其中54例行VATS，73例行传统经胸骨扩大胸腺切除术（TS）。比较VATS组和TS组的手术细节、异位胸腺组织发现、术后血清免疫球蛋白和补体成分浓度以及T细胞免疫情况。
两组患者的年龄、性别、术前MG病程和手术时间无差异。接受VATS的患者术后入住重症监护病房的时间较短（P = 0.02），失血量较少（P = 0.01），异位胸腺组织的概率较低。VATS组和TS组在血清IgG和C3浓度以及CD4(+)和CD8(+) T细胞计数方面存在显著的细胞免疫差异。VATS患者术后第1天和第3天血清IgG浓度略有升高。两组术后C3浓度均逐渐升高，但术后第7天下降。VATS组术后CD4(+)和CD8(+) T细胞计数相对稳定，但TS组术后第1天和第3天显著升高，术后第7天CD4(+) T细胞下降，CD8(+) T细胞未下降。
非胸腺瘤性MG的VATS具有短期优势，对细胞免疫反应的影响小于开放性切除术。
