CAJ | 학술논문

目的评价电视胸腔镜胸腺扩大切除治疗重症肌无力的手术方法、安全性、技术要点和疗效.方法重症肌无力患者131例中,Ⅰ型31例,Ⅱa型43例,Ⅱb型42例,Ⅲ型14例,Ⅳ型1例,在全身麻醉下经右胸入路行胸腔镜下胸腺扩大切除术,术中打开前上纵隔胸膜,暴露胸腺组织,用锐性和钝性方法游离完整切除胸腺左右叶及心包前脂肪,评估术后疗效.结果所有患者手术顺利,手术时间30～270 min,平均(89±31) min；术中出血量20 ～400 ml,平均(53 ±21)ml；术后住院时间为4～12d,平均(7.3±2.3)d.术后并发重症肌无力危象11例(8.4％),并发肺炎19例(14.5％),无死亡病例.术后病理:单纯胸腺增生99例,合并胸腺瘤31例,恶性胸腺瘤1例.术后随访109例,随访时间12 ～ 72个月,平均(38±20)个月,失访12例(9.2％).完全缓解51例(46.8％)、部分缓解47例(43.1％)、稳定8例(7.3％)、恶化3例(2.8％),总缓解率89.9％.结论电视胸腔镜胸腺扩大切除术是目前治疗重症肌无力的有效术式,具有微创、安全、疗效确切、手术时间短、术后恢复快、并发症少等优点.
목적 평개전시흉강경흉선확대절제치료중증기무력적수술방법、안전성、기술요점화료효.방법 중증기무력환자131례중,Ⅰ형31례,Ⅱa형43례,Ⅱb형42례,Ⅲ형14례,Ⅳ형1례,재전신마취하경우흉입로행흉강경하흉선확대절제술,술중타개전상종격흉막,폭로흉선조직,용예성화둔성방법유리완정절제흉선좌우협급심포전지방,평고술후료효.결과 소유환자수술순리,수술시간30～270 min,평균(89±31) min；술중출혈량20 ～400 ml,평균(53 ±21)ml；술후주원시간위4～12d,평균(7.3±2.3)d.술후병발중증기무력위상11례(8.4％),병발폐염19례(14.5％),무사망병례.술후병리:단순흉선증생99례,합병흉선류31례,악성흉선류1례.술후수방109례,수방시간12 ～ 72개월,평균(38±20)개월,실방12례(9.2％).완전완해51례(46.8％)、부분완해47례(43.1％)、은정8례(7.3％)、악화3례(2.8％),총완해솔89.9％.결론 전시흉강경흉선확대절제술시목전치료중증기무력적유효술식,구유미창、안전、료효학절、수술시간단、술후회복쾌、병발증소등우점.
Objective To evaluate the surgical methods,security,technical points and efficacy of videoassisted thoracoscopic extended thymectomy for myasthenia gravis.Methods There were 131 cases of myasthenia gravis (MG),31 cases of type Ⅰ,43 cases of type Ⅱa,42 cases of type Ⅱb,14 cases of type Ⅲ and 1 case of type Ⅳ.All patients underwent video-assisted thoracoscopic extended thymectomy under general anesthesia through the right chest approach.We opened the front upper mediastinal pleura to expose thymus tissue and did complete removal of the thymus and pericardial fat by sharp and blunt method.The curative effect was evaluated.Results The operation time ranged from 30 to 270 min (89 ± 31 min) ; intraoperative blood loss ranged from 20 to 400 ml (53 ±21 ml) and postoperative hospital stay ranged from 4 to 12 d(7.3 ±2.3 d).Postoperative myasthenia gravis crisis occurred in 11 cases (8.4％) and pneumonia occurred in 19 cases (14.5％).There was no postoperative mortality.Pathology:99 cases had simple thymic hyperplasia; 31 cases had thymoma and 1 case had malignant thymoma.Postoperative follow-up was done with 109 cases and the follow-up time ranged from 12 to 72 months (38 ± 20 months).12 patients (9.2％) failed to be followed up.51 cases achieved complete remission(46.8％).47 cases achieved partial remission (43.1％).8 cases were stable(7.3 ％).3 cases deteriorated (2.8％) ; the total remission rate was 89.9％.Conclusions Video-assisted thoracoscopic thymus extended resection is an effective technique for the treatment of myasthenia gravis,which avoids the trauma brought by traditional thoracotomy and is considered to be minimally invasive,safe and efficient with a short operative time and rapid postoperative recovery.