摘要
目的总结胸腔镜胸腺切除术治疗重症肌无力（MG）的经验，对比胸腺瘤和非胸腺瘤MG患者的术后效果，分析胸腔镜联合纵隔镜和单纯胸腔镜治疗非胸腺瘤IVIG的远期效果。方法2001年至2011年，采用胸腔镜胸腺扩大切除术治疗MG患者500例，根据是否合并胸腺瘤和术中是否联合纵隔镜分组：胸腔镜胸腺瘤组（A组）118例，胸腔镜非胸腺瘤组（B组）301例，胸腔镜联合纵隔镜非胸腺瘤组（C组）81例。结果全组无术中死亡。完全电视胸腔镜下完成手术495例。A组手术（128．5±77．8）min，术后24．6％患者出现肌无力危象；B组手术（111．3±31．6）min，术后11．0％患者出现肌无力危象；C组手术（145．0±71．6）min，术后9．9％患者出现肌无力危象。术后随访3个月至11年，A、B、C组患者完全缓解率（CSR）分别为28．7％、37．3％、36．5％。无病生存曲线示术后3年B、C组CSR高于A组，术后5年C组CSR高于B组。术后第5年C组CSR接近60％，B组为50％，而A组仅为36％。结论胸腔镜基础上联合纵隔镜胸腺扩大切除手术清除颈部、前纵隔脂肪组织及异位胸腺更为彻底，远期效果更加理想。与非胸腺瘤MG患者相比，胸腺瘤MG患者术后远期效果较差。
Objective To review video-assisted thoracoscopic thymectomy as a treatment for myasthenia gravis （ MG）, compare outcomes of thoracoscopie thymeetomy for thymoma and non-thymoma MG, and assess the efficacy of Video-assisted Thoracoseopic Extended Thymeetomy （VATET） combined with mediastinoscopy. Methods A retrospective review of 500 patientswith MG who underwent VATS thymeetomy between 2001 and 2011 has been done. They were divided into three groups： 118 cases of thymoma MG group , thoracoseopy for non-thymoma MG group 301cases, and VATET for non-thymoma MG group 81 cases. Results There was no mortality. Thoraeoseopie thymectomy was successfully performed for 495 cases. In the thoracoseopy group for non-thymoma M G, the operating time is （111.3 ± 31.6） min, 11.0% having post-operative myasthenie crises; in the VATET group, the operating time is （ 145.0 ±71.6） min, 9.9% having post-operative myasthenic crises; in the thymoma MG group, the operating time is （ 128.5 ± 77.8 ） min, 24.6% having post-operative myasthenie crises. During the follow-up, CSR was 37.3% ,36.5% and 28.7% in the groups of thoracoseopy for non-thymoma MG, VATET and thymoma MG respectively. However, the disease-free survival curve shows that CSR of the thymoma MG group became lower than other two groups 3 years after surgery, and CSR of the VATET group becoming higher than that of thoracoscopy for non-thymoma MG group 5 years after surgery. CSRs of groups of thoraeoseopy for non-thymoma MG, VATET and thymoma MG might reach 50%, 60% and 36%. Conclusion The VATET combined with mediastinoseopy has a better long-term outcome because the more thymus might be removed comparing with non-thymoma MG, thoracoscopie thymectomy for thymoma MG had a worse long-term outcome.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2013年第5期290-293,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
重症肌无力
胸腺瘤
外科手术
微创性
胸腺切除术
Myasthenia gravis
Thymoma
Surgical procedures, minimally invasive
Thymectomy
