Department of Thoracic Surgery, Military Hospital 103, Vietnam Military Medical University, Hanoi, Viet Nam.
Department of ICU, Military Hospital 103, Vietnam Military Medical University, Hanoi, Viet Nam.
Asian J Surg. 2021 Jan;44(1):369-373. doi: 10.1016/j.asjsur.2020.10.006. Epub 2020 Nov 7.
To investigate clinical and histopathological characteristics of Vietnamese patients with thymoma and myasthenia gravis (MG), and the outcomes of surgical management using video-assisted thoracoscopic surgery (VATS) thymectomy.
A prospective study was carried out on 61 patients undergoing VATS thymectomy for MG class I, IIA with thymoma in the period from 10/2013 to 5/2019. The WHO histopathological classification, Masaoka's stages and MG grading using the guidelines of the Medical Scientific Advisory Board of the Myasthenia gravis foundation of America (MGFA) were used. All patients were followed up at 1 month, 6 months and over 1 year postoperatively.
The average patient age was 47.3 ± 10.8 years (21-70). The female/male ratio was 0.91.80.3% of patients had MG class IIA. Most of the patients were at Masaoka's stage I and stage II (75.4%). Only 1 patient (1.7%) had highly malignant type B3 thymoma. Conversion to open surgery was required in 8 patients. The surgical time was 91.8 ± 49.9 min and blood loss was 37.3 ± 31.5 ml. Most patients (68.9%) were extubated in the operating room. The postoperative hospital stay was 9.8 ± 5.9 days (5-37 days). 22.6% of patients relapsed after one-year. Refractory MG declined to 5.7% after surgical treatment.
VATS thymectomy for MG with thymoma was safe and effective, with a lower rate of intraoperative complications, shorter hospitalization, and better long-term outcomes. This approach could be applicable for patients of all age groups with thymomas at early Masaoka's stages.
研究越南胸腺瘤合并重症肌无力（MG）患者的临床和组织病理学特征，以及使用电视辅助胸腔镜手术（VATS）胸腺切除术的手术治疗结果。
对 2013 年 10 月至 2019 年 5 月期间 61 例行 VATS 胸腺切除术的 MG Ⅰ、ⅡA 合并胸腺瘤患者进行前瞻性研究。采用世界卫生组织（WHO）组织病理学分类、Masaoka 分期和美国重症肌无力基金会（MGFA）医学科学咨询委员会指南进行 MG 分级。所有患者均在术后 1 个月、6 个月和 1 年以上进行随访。
患者平均年龄为 47.3±10.8 岁（21-70 岁）。女性/男性比例为 0.91。80.3%的患者为 MG ⅡA 型。大多数患者处于 MasaokaⅠ期和Ⅱ期（75.4%）。仅 1 例（1.7%）患者为高度恶性 B3 型胸腺瘤。8 例患者需要转为开胸手术。手术时间为 91.8±49.9 分钟，出血量为 37.3±31.5 毫升。大多数患者（68.9%）在手术室拔管。术后住院时间为 9.8±5.9 天（5-37 天）。1 年后 22.6%的患者复发。手术后难治性 MG 下降至 5.7%。
VATS 胸腺切除术治疗 MG 合并胸腺瘤安全有效，术中并发症发生率低，住院时间短，长期效果好。这种方法适用于所有年龄组、早期 Masaoka 分期的胸腺瘤患者。
