中国微创外科杂志
中國微創外科雜誌
중국미창외과잡지
CHINESE JOURNAL OF MINIMALLY INVASIVE SURGERY
2014年
4期
340-341
,共2页
苏雷%支修益%张毅%许庆生%刘宝东%陈东红%胡牧%刘磊%钱坤%李元博
囌雷%支脩益%張毅%許慶生%劉寶東%陳東紅%鬍牧%劉磊%錢坤%李元博
소뢰%지수익%장의%허경생%류보동%진동홍%호목%류뢰%전곤%리원박
胸腔镜%扩大胸腺切除%非胸腺瘤性重症肌无力
胸腔鏡%擴大胸腺切除%非胸腺瘤性重癥肌無力
흉강경%확대흉선절제%비흉선류성중증기무력
Thoracoscopy%Extended thymectomy%Non-neoplastic myasthenia gravis
目的：探讨胸腔镜辅助治疗非胸腺瘤性重症肌无力（ non-thymoma myasthenia gravis ，non-TMG）的价值。方法2007年1月～2011年8月，对62例non-TMG行胸腔镜辅助胸腺扩大切除术。男24例，女38例。年龄18～67岁，平均31岁。根据改良Osserman分型，Ⅰ型17例，Ⅱa型28例，Ⅱb型15例，Ⅲ型2例。按美国重症肌无力协会标准（ MGFA）进行疗效判定。结果全组无手术死亡，手术时间40～150 min，平均110 min。术后保留胸腔引流管时间1～5 d，平均2．0 d。术后7天内脱离呼吸机57例，超过7天5例。62例术后病理诊断结果均显示胸腺增生，合并胸腺外脂肪（心包及双侧心膈角）内查见胸腺小体22例。术后随访2～5年，平均4．2年。完全稳定缓解31例，药物缓解17例，微小症状表现6例，改善8例。结论胸部CT扫描尚不能根据胸腺本身“体积”大小判断胸腺增生与否。术中应重视迷走胸腺组织清除。胸腔镜下胸腺扩大切除术是治疗non-TMG有效的手段。
目的：探討胸腔鏡輔助治療非胸腺瘤性重癥肌無力（ non-thymoma myasthenia gravis ，non-TMG）的價值。方法2007年1月～2011年8月，對62例non-TMG行胸腔鏡輔助胸腺擴大切除術。男24例，女38例。年齡18～67歲，平均31歲。根據改良Osserman分型，Ⅰ型17例，Ⅱa型28例，Ⅱb型15例，Ⅲ型2例。按美國重癥肌無力協會標準（ MGFA）進行療效判定。結果全組無手術死亡，手術時間40～150 min，平均110 min。術後保留胸腔引流管時間1～5 d，平均2．0 d。術後7天內脫離呼吸機57例，超過7天5例。62例術後病理診斷結果均顯示胸腺增生，閤併胸腺外脂肪（心包及雙側心膈角）內查見胸腺小體22例。術後隨訪2～5年，平均4．2年。完全穩定緩解31例，藥物緩解17例，微小癥狀錶現6例，改善8例。結論胸部CT掃描尚不能根據胸腺本身“體積”大小判斷胸腺增生與否。術中應重視迷走胸腺組織清除。胸腔鏡下胸腺擴大切除術是治療non-TMG有效的手段。
목적：탐토흉강경보조치료비흉선류성중증기무력（ non-thymoma myasthenia gravis ，non-TMG）적개치。방법2007년1월～2011년8월，대62례non-TMG행흉강경보조흉선확대절제술。남24례，녀38례。년령18～67세，평균31세。근거개량Osserman분형，Ⅰ형17례，Ⅱa형28례，Ⅱb형15례，Ⅲ형2례。안미국중증기무력협회표준（ MGFA）진행료효판정。결과전조무수술사망，수술시간40～150 min，평균110 min。술후보류흉강인류관시간1～5 d，평균2．0 d。술후7천내탈리호흡궤57례，초과7천5례。62례술후병리진단결과균현시흉선증생，합병흉선외지방（심포급쌍측심격각）내사견흉선소체22례。술후수방2～5년，평균4．2년。완전은정완해31례，약물완해17례，미소증상표현6례，개선8례。결론흉부CT소묘상불능근거흉선본신“체적”대소판단흉선증생여부。술중응중시미주흉선조직청제。흉강경하흉선확대절제술시치료non-TMG유효적수단。
Objective To explore the effect of video-assisted thoracoscopic surgery for non-thymoma myasthenia gravis ( non-TMG) . Methods A total of 62 cases of non-TMG underwent video-assisted thoracoscopic extended thymectomy in our hospital from January 2007 to August 2011.The patients included 24 males and 38 females, aged 18 to 67 ( average, 31).According to the modified Osserman classification , there were 17 cases of type Ⅰ, 28 cases of type Ⅱa, 15 cases of type Ⅱb and 2 cases of type Ⅲ. The efficacy of the surgery was determined by the standard of Myasthenia Gravis Foundation of America ( MGFA ) . Results No operative mortality occurred and the operative time was 40-150 min ( mean, 110 min) .Postoperative chest catheterization lasted 1-5 d (average, 2.0 d).A total of 57 cases were extubated from the ventilator within 7 days and 5 cases after more than 7 days. Postoperative pathological diagnosis showed thymic hyperplasia in all cases , while thymic corpuscles were found in thymic external fat (pericardial and bilateral cardiophrenic angle area ) in 22 cases.Postoperative follow-up was 2 -5 years (average, 4.2 years). Complete stable remission was found in 31 cases, drug remission in 17 cases, slight symptoms in 6 cases and improvement in 8 cases. Conclusions The thymus “size” shown in the chest CT scan could not determine thymic hyperplasia .Vagus thymic tissue removal should be noticed during the surgery .Extended thymectomy under thoracoscopy is an effective treatment for non -TMG.
