摘要
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。
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.
出处
《中国微创外科杂志》
CSCD
2014年第4期340-341,共2页
Chinese Journal of Minimally Invasive Surgery
基金
首都医科大学校长研究基金(11JYY61)
