Vigneshwaran B, Bhoi Sanjeev Kumar, Sable Mukund Namdev, Muduly Dillip, Sultania Mahesh, Jha Menkha, Mohakud Sudipta, Kar Madhabananda
Department of Surgical Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Department of Neurology, All India Institute of Medical Sciences, Odisha, India.
J Minim Access Surg. 2022 Jan-Mar;18(1):111-117. doi: 10.4103/jmas.JMAS_261_20.
The purpose of this study was to identify the factors which predict the perioperative outcomes after video-assisted thoracoscopic surgery (VATS) thymectomy in patients with myasthenia gravis (MG) or thymic neoplasms.
Data of consecutive patients who had undergone VATS thymectomy in our institution from August 2016 to April 2018 were collected retrospectively from a prospectively maintained database followed by prospective recruitment of patients who underwent VATS thymectomy from April 2018 to February 2020.
A total of 31 patients were included. Females were more common (51.6%), and 29 patients (93.5%) had MG. The most common indication for thymectomy was the presence of both MG and thymoma (51.6%). Most MG patients had moderate disease (55.2%) or severe (24.1%) disease preoperatively. Mean operative time and blood loss were 196.9 ± 63.5 min and 122.5 ± 115.3 ml, respectively. Mean hospital stay was 7.9 ± 6.7 days. The rate of major and minor complications was 16.18% and 35.4%, respectively. Multivariate linear regression analysis established that MG symptoms >12 months, prolonged invasive ventilation (intubation ≥24 h), and complications were associated significantly with a prolonged hospital stay. Adjusting for outliers, pre-operative disease severity (MG Foundation of America class), and intubation ≥24 h were the only factors that had a significant impact on perioperative outcomes.
Pre-operative disease severity and post-operative invasive ventilation are strong determinants of perioperative outcomes. Pre-operative optimisation and early extubation protocols can further reduce morbidity in patients undergoing thymectomy by the VATS approach.
本研究旨在确定预测重症肌无力（MG）或胸腺肿瘤患者行电视辅助胸腔镜手术（VATS）胸腺切除术后围手术期结局的因素。
回顾性收集2016年8月至2018年4月在我院接受VATS胸腺切除术的连续患者的数据，这些数据来自一个前瞻性维护的数据库，随后前瞻性纳入2018年4月至2020年2月接受VATS胸腺切除术的患者。
共纳入31例患者。女性更为常见（51.6%），29例患者（93.5%）患有MG。胸腺切除最常见的指征是同时存在MG和胸腺瘤（51.6%）。大多数MG患者术前病情为中度（55.2%）或重度（24.1%）。平均手术时间和失血量分别为196.9±63.5分钟和122.5±115.3毫升。平均住院时间为7.9±6.7天。主要和次要并发症发生率分别为16.18%和35.4%。多因素线性回归分析表明，MG症状持续>12个月、有创通气时间延长（插管≥24小时）和并发症与住院时间延长显著相关。排除异常值后，术前疾病严重程度（美国重症肌无力基金会分级）和插管≥24小时是仅对围手术期结局有显著影响的因素。
术前疾病严重程度和术后有创通气是围手术期结局的重要决定因素。术前优化和早期拔管方案可进一步降低VATS胸腺切除术患者的发病率。
