【摘要】 目的通过电视胸腔镜手术(VATS)与传统经胸骨正中开胸行胸腺扩大切除术治疗重症肌无力(MG)的临床疗效比较,探讨VATS治疗重症肌无力的临床应用价值。方法将两组病人分别通过VATS和开胸方式行胸腺完整切除和前纵隔脂肪组织廓清术来治疗MG,比较2组在手术时间、术中出血量、术后胸管放置时间、术后住院时间、术后发生重症肌无力危象和疗效等方面的异同。结果VATS组手术时间(93±20.5)min、术中出血量(150±15.4)mL、术后胸管放置(2.5±1.4)d、术后住院(7.5±1.4)d等优于开胸组(122±26.3)min、(210±45.3)mL、(4.0±1.8)d、(9.5±1.7)d,各项指标差异具有统计学意义;VATS组有1例术中诊断为恶性胸腺瘤改为正中开胸手术,开胸组有1例并发重症肌无力危象,两组围术期均无临床死亡。随访6~24月,VATS组和开胸组术后缓解好转率分别为83.3%、80.0%,两组间差异无统计学意义(P>0.05)。结论VATS下行胸腺扩大切除术是安全、可行的,具有创伤小、恢复快和疗效可靠等优点,但对于恶性胸腺瘤合并重症肌无力的患者,建议开胸手术为宜。更多还原

【Abstract】 Objective To investigate the value of video-assisted thoracoscopic surgery (VATS) by comparing the clinic effect of VATS and thymectomy in the treatment of myasthenia gravis(MG). Methods Twenty-two patients who were confirmed to be MG preoperatively from February 2002 to July 2006 were divided into VATS group (12 cases) and thoracotomy group (10 cases). Thymectomy and dissection of all faity tissue anterior to pericardium were performed in both groups. To compare the operative time, blood loss during operation, the time of postoperative drainage tube left in chest, postoperative hospitalization days, MG crisis after operation and the curative effect in two groups.Results All indexes of VATS group were super to those of thoracotomy group (P<0.05) . In VATS group, one case confirmed to be malignant thymoma during operation received thoracotomy instead. One case complicated with MG crisis was found in thoracomy group. There was no mortality in two groups. During a follow-up of 6-24 months, symptom was improved in 83.3% of patients in VATS group and 80.0% in thoracotomy group (P>0.05).Conclusion Maximal thymectomy with VATS is safe and feasible with the advantages of less invasion, quick recovery and good curative effect. It is an ideal choice for the surgical treatment of MG without complication of malignant thymoma .更多还原