胸腔镜胸腺切除术治疗重症肌无力500例
VATS thymectomy for myasthenia gravis: a retrospective review of 500 cases
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MG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.
更多Objective To review video-assisted thoracoscopic thymectomy as a treatment for myasthenia gravis (MG),compare outcomes of thoracoscopic thymectomy for thymoma and non-thymoma MG,and assess the efficacy of Video-assisted Thoracoscopic Extended Thymectomy (VATET) combined with mediastinoscopy.Methods A retrospective review of 500 patientswith MG who underwent VATS thymectomy between 2001 and 2011 has been done.They were divided into three groups:118 cases of thymoma MG group,thoracoscopy for non-thymoma MG group 301cases,and VATET for non-thymoma MG group 81cases.Results There was no mortality.Thoracoscopic thymectomy was successfully performed for 495 cases.In the thoracoscopy group for non-thymoma MG,the operating time is (111.3 ± 31.6) min,11.0% having post-operative myasthenic 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 myasthenic crises.During the follow-up,CSR was 37.3%,36.5% and 28.7% in the groups of thoracoscopy 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 nou-thymoma MG group 5 years after surgery.CSRs of groups of thoracoscopy for non-thymoma MG,VATET and thymoma MG might reach 50%,60% and 36%.Conclusion The VATET combined with mediastinoscopy has a better long-term outcome because the more thymus might be removed comparing with non-thymoma MG,thoracoscopic thymectomy for thymoma MG had a worse long-term outcome.
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