Balasingam Dinesh Francis K, Dharmaraj Benedict, Chai Diong Nguk, Balasubbiah Narendran, Meiyappan Palaniappan, Sathiamurthy Narasimman
Division of Thoracic Surgery, Department of General Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
J Thorac Dis. 2024 Nov 30;16(11):7446-7457. doi: 10.21037/jtd-24-830. Epub 2024 Nov 8.
The standard treatment for thymomatous myasthenia gravis (TMG) patients is thymectomy, whereas its role in non-TMG (NTMG) is still under debate. The objective of this study is to assess myasthenia gravis (MG) outcomes of thymectomy using the uniportal video-assisted thoracoscopic surgery (UVATS) technique for both groups and evaluate the procedure's efficacy and safety.
We retrospectively collected data from January 2019 to December 2022 at Hospital Kuala Lumpur. The Myasthenia Gravis Activities of Daily Living (MG-ADL) scoring and the Myasthenia Gravis Foundation of America's Post Interventional Score (MGFA-PIS) measured our primary outcome. Secondary outcomes included surgery-related morbidity. All patients underwent a UVATS thymectomy, with the incision at the right anterior axillary line at the 5 intercostal space.
Out of 26 patients, 22 were analysed. The MG-ADL scores indicated a significant mean score reduction post-surgery [6.9; 95% confidence interval (CI): 4.42 to 9.67; P<0.001]. NTMG patients exhibited a greater decrease in MG-ADL mean score than TMG patients {9.5 [standard deviation (SD) 4.8] . 6.1 (SD 5.4) P<0.001}. The MGFA-PIS showed complete stable remission (CSR) rates of 43% for TMG and 25% for NTMG patients. Surgical morbidity was observed in 13% of patients, of which were myasthenic crisis, difficult extubation due to carbon dioxide (CO) retention and subcutaneous emphysema.
Thymectomy via UVATS is an effective and safe approach for improving symptoms in both TMG and NTMG patients.
胸腺瘤型重症肌无力（TMG）患者的标准治疗方法是胸腺切除术，而其在非胸腺瘤型重症肌无力（NTMG）中的作用仍存在争议。本研究的目的是评估采用单孔电视辅助胸腔镜手术（UVATS）技术对两组患者进行胸腺切除术后的重症肌无力（MG）治疗效果，并评估该手术的有效性和安全性。
我们回顾性收集了2019年1月至2022年12月在吉隆坡医院的数据。采用重症肌无力日常生活活动（MG-ADL）评分和美国重症肌无力基金会介入后评分（MGFA-PIS）来衡量我们的主要结局。次要结局包括手术相关的发病率。所有患者均接受UVATS胸腺切除术，切口位于右腋前线第5肋间。
26例患者中，22例进行了分析。MG-ADL评分显示术后平均评分显著降低[6.9；95%置信区间（CI）：4.42至9.67；P<0.001]。NTMG患者的MG-ADL平均评分下降幅度大于TMG患者{9.5[标准差（SD）4.8]. 6.1（SD 5.4）P<0.001}。MGFA-PIS显示，TMG患者的完全稳定缓解（CSR）率为43%，NTMG患者为25%。13%的患者出现手术并发症，包括肌无力危象、因二氧化碳（CO）潴留导致的拔管困难和皮下气肿。
通过UVATS进行胸腺切除术是改善TMG和NTMG患者症状的一种有效且安全的方法。
