【摘要】 背景与目的胸腺切除已成为重症肌无力(myasthenia gravis, MG)治疗的重要组成部分,近年来,经电视胸腔镜(video-assisted thoracoscopic surgery, VATS)胸腺扩大切除得到广泛应用。传统VATS术式多需3个经肋间切口,本研究改良了手术入路和操作方式,现总结单操作孔VATS胸腺扩大切除治疗MG的效果。方法回顾性分析2017年7月-2018年12月北京医院胸外科应用单操作孔VATS行胸腺扩大切除术的45例MG患者资料,总结其手术安全性和疗效。结果本组45例均顺利完成胸腺扩大切除,无中转开胸、增加切口和围术期死亡,平均手术时间(141.3±39.2)min,平均术中出血量(64.2±45.5)m L,中位胸腔引流管留置时间3 d,平均胸腔引流量(890.4±439.1)m L,中位术后住院时间6 d。围术期并发症13例(28.9%),其中肌无力危象5例(11.1%),肺部并发症6例(13.3%),切口愈合不良4例(8.9%),房颤4例(8.9%),迟发性心包积血1例(2.2%)。中位随访时间18.5个月,统计术后1年的疗效,药物缓解1例(2.2%),微小症状表现18例(40.0%),改善23例(51.1%),无变化1例(2.2%),加重2例(4.4%)。结论单操作孔胸腔镜下胸腺扩大切除术治疗MG的手术安全性和疗效良好,围术期应注意预防肌无力危象、肺部并发症和切口并发症。更多还原

【Abstract】 Backgroud and objective Thymectomy plays an important role in patients with myasthenia gravis(MG) and video-assisted thoracoscopic(VATS) extended thymectomy has been widely used in recent years. The traditional thoracoscopic procedure requires three intercostal incisions. Our study improved the surgical approach and operation method by using single-utility port thoracoscopy. The aim of this study was to evaluate the effect of single-utility port VATS extended thymectomy for MG. Methods A retrospective analysis was performed in 45 patients with MG who underwent single-utility port VATS extended thymectomy in Beijing Hospital from July 2017 to December 2018. The safety and effectiveness of this surgical approach were summarized. Results All operations were accomplished successfully, without conversion to thoracotomy, requirement of additional incisions or postoperative death. The mean operation time was(141.3±39.2) min; the mean intraoperative blood loss was(64.2±45.5) m L; the median thoracic drainage duration was 3 days(range 2 days to 8 days); the mean pleural drainage was(890.4±439.1) m L, and the median postoperative hospital stay was 6 days(range 3 days to 91 days). There were 13 cases(28.9%) with postoperative complications, including 5 cases(11.1%) with myasthenia crisis, 6 cases(13.3%) with pulmonary complications, 4 cases(8.9%) with poor incision healing, 4 cases(8.9%) with atrial fibrillation, and 1 case(2.2%) with delayed pericardial hemorrhage. The median follow-up time was 18.5 months(range 12.5 months to 29.2 months). According to the effect of 1 year after surgery, 1 case(2.2%) showed pharmacologic remission; 18 cases(40.0%) showed minimal manifestations; 23 cases(51.1%) got improvement; 1 case(2.2%) showed no changs and 2 cases(4.4%) were worse. Conclusion Single-utility port VATS extended thymectomy is a safe and feasible minimally invasive procedure for MG.During the perioperative period, special attention should be paid to prevent myasthenic crisis, pulmonary complications, and incision complications.更多还原