Thoracic Surgery Department, Hospital Pulido Valente - Centro Hospitalar Lisboa Norte, Portugal.
Port J Card Thorac Vasc Surg. 2024 May 13;31(1):23-28. doi: 10.48729/pjctvs.345.
Myasthenia gravis (MG) is an autoimmune, neurologic disease that causes a wide range of symptoms. While the transsternal, transcervical and thoracotomy approaches are accepted as effective, there is still debate regarding the VATS approach.
We analyzed our center's surgical experience with thymectomy for myasthenia gravis, comparing the results of patients operated on using VATS and more invasive approaches, over a period of 10 years. A search of the department's surgical database for myasthenia gravis cases between January 2010 and January 2021, revealed a total of 40 cases. Twenty-four patients were included in the final analysis and were distributed into two groups: the VATS procedure group (group A) and the open procedure group (group B). The latter included sternotomy, thoracotomy, transcervical and hemiclamshell approaches. Only radical thymectomies were included. The established outcomes were clinical improvement defined as asymptomatic remission, reduction, or discontinuation of the medication necessary to achieve optimal symptom control.
The median follow-up time was 27 months (ranging from 4 to 75 months). Videothoracoscopy radical thymectomy was performed on 12 patients. Complete remission with no medication was achieved in 1 case (8.3%), while 2 patients (16.7%) became asymptomatic with reduced medication. An improvement (reduced symptoms or decreased medication) was observed in 8 cases (66.6%). No change in clinical outcome was noted in 1 patient (8.3%). None of the patients reported worsening symptoms. Open thymectomy was performed on 12 patients. Complete remission with no medication was achieved in 1 case (8.3%), while 2 patients (16.7%) became asymptomatic with reduced medication. An improvement was noted in 6 cases (50%). No change in clinical outcome was observed in 3 patients (25%) whereas 2 of them (16.7%) experienced slightly better symptom control but with a significant increase in medication. One patient (8.3%) described the clinical results as without any significant change. None of the patients reported worsening symptoms.
The videotoracoscopic approach in the treatment of myasthenia gravis is non-inferior compared to the open approach and effective in a long-term follow-up, offering all the additional benefits of less invasive surgery.
重症肌无力（MG）是一种自身免疫性神经系统疾病，可引起多种症状。虽然经胸骨正中切开术、经颈入路和开胸术被认为是有效的，但对于胸腔镜手术（VATS）方法仍存在争议。
我们分析了我们中心在重症肌无力胸腺切除术方面的手术经验，比较了 10 年来通过 VATS 和更具侵袭性方法进行手术的患者的结果。在 2010 年 1 月至 2021 年 1 月期间，对科室的手术数据库进行了重症肌无力病例的检索，共发现 40 例。24 例患者纳入最终分析，并分为两组：VATS 组（A 组）和开放手术组（B 组）。后者包括胸骨正中切开术、开胸术、经颈入路和半开胸术。仅纳入根治性胸腺切除术。既定的结果是临床改善，定义为无症状缓解、减少或停止药物治疗以达到最佳症状控制。
中位随访时间为 27 个月（4 至 75 个月）。12 例患者行胸腔镜下根治性胸腺切除术。1 例（8.3%）达到完全缓解且无需药物治疗，2 例（16.7%）症状减轻且药物减少。8 例（66.6%）患者症状改善（减轻或减少药物治疗）。1 例（8.3%）患者临床结果无变化。无一例患者报告症状恶化。12 例患者行开放胸腺切除术。1 例（8.3%）达到完全缓解且无需药物治疗，2 例（16.7%）症状减轻且药物减少。6 例（50%）患者症状改善。3 例（25%）患者临床结果无变化，其中 2 例（16.7%）药物增加但症状控制略有改善。1 例（8.3%）患者报告临床结果无明显变化。无一例患者报告症状恶化。
与开放手术相比，胸腔镜手术治疗重症肌无力不劣效，且在长期随访中有效，具有微创手术的所有额外益处。
