Shiomi Kazu, Kitamura Eiji, Ono Mototsugu, Kondo Yasuto, Naito Masahito, Mikubo Masashi, Matsui Yoshio, Nishiyama Kazutoshi, Suda Takashi, Satoh Yukitoshi
Department of Thoracic Surgery, Kitasato University School of Medicine, Kanagawa, Japan.
Department of Medicine (Neurology), Kitasato University School of Medicine, Kanagawa, Japan.
J Thorac Dis. 2018 Mar;10(3):1747-1752. doi: 10.21037/jtd.2018.01.168.
We have used a promising, minimally invasive thoracoscopic technique of extended thymectomy for patients with myasthenia gravis (MG). The aim of this study was to report our promising technique, a modified single-port trans-subxiphoid approach (MTXA) and to compare perioperative outcomes and effects on MG between our approach and sternotomy.
We retrospectively reviewed records of all patients undergoing extended thymectomy for MG and/or thymoma between January 1, 2010 and December 31, 2016. The patients were divided into the MTXA group and Sternotomy group.
Of the 50 consecutive patients undergoing extended thymectomy for MG, finally, 13 patients undergoing our MTXA extended thymectomy technique were compared with 20 patients undergoing extended thymectomy via sternotomy. Intraoperative blood loss, postoperative length of stay, and C-reactive protein value on postoperative day 1 were significantly more favorable in the MTXA group than the Sternotomy group (P<0.0001, P=0.0040 and P=0.0073, respectively). Furthermore, no significant differences in the frequency of patients with improvement of their Quantitative Myasthenia Gravis score and/or MG-Activities of Daily Living scale, decrease in the serum level of acetylcholine receptor antibody, and dose reduction of oral prednisone were seen between the two groups.
Our approach to extended thymectomy might be more favorable than sternotomy in patients with MG.
我们已将一种有前景的、微创的胸腔镜扩大胸腺切除术应用于重症肌无力（MG）患者。本研究的目的是报告我们有前景的技术，即改良单孔剑突下入路（MTXA），并比较我们的方法与胸骨切开术的围手术期结果及对MG的影响。
我们回顾性分析了2010年1月1日至2016年12月31日期间所有接受MG和/或胸腺瘤扩大胸腺切除术患者的记录。将患者分为MTXA组和胸骨切开术组。
在连续50例接受MG扩大胸腺切除术的患者中，最终将13例行我们的MTXA扩大胸腺切除技术的患者与20例行胸骨切开术扩大胸腺切除术的患者进行比较。MTXA组的术中失血量、术后住院时间和术后第1天的C反应蛋白值均显著优于胸骨切开术组（分别为P<0.0001、P=0.0040和P=0.0073）。此外，两组在重症肌无力定量评分和/或MG日常生活活动量表改善的患者频率、血清乙酰胆碱受体抗体水平降低以及口服泼尼松剂量减少方面均无显著差异。
对于MG患者，我们的扩大胸腺切除方法可能比胸骨切开术更具优势。
