胸腔镜与胸骨劈开胸腺切除术治疗重症肌无力的中远期疗效比较  

Mid-,and long-term effects of video-assisted thoracoscopic and transsternal thymectomy in treatment of non-thymomatous myasthenia gravis:analysis of 204 cases

作　　者：于磊[1] 王天佑[1] 马山[1] 景筠[1] 李建业[1] 蒋俭[1] 张云峰[1] 臧楠[1] 霍承瑜[1] 

机构地区：[1]首都医科大学附属北京同仁医院胸外科,100730

出　　处：《中华医学杂志》2007年第45期3171-3173,共3页National Medical Journal of China

基　　金：世界抗癌基金(YUCC ICR/06/163/2006)

摘　　要：目的通过比较胸腔镜与胸骨劈开胸腺切除术治疗重症肌无力的疗效,探讨胸腔镜胸腺切除术治疗重症肌无力的有效性。方法回顾行分析1991年至2003年采用胸腺切除术治疗的重症肌无力(非胸腺瘤)患者204例,其中胸骨劈开术161例,术后随访5年;胸腔镜手术43例,术后随访3年。结果胸腔镜组平均手术时间(132±32)min,术后发生肌无力危象4例,术后1、3年的完全稳定缓解(CSR)分别是34.9%和46.5%;而胸骨劈开组平均手术时间为(96±18)min,肌无力危象41例,术后1、3、5年的 CSR 分别是26.7%、35.4%和40.4%。结论胸腔镜下胸腺切除术能取得胸骨正中劈开手术同样理想的中远期治疗效果。对重症肌无力患者应尽早行胸腔镜下胸腺切除手术。Objective To evaluate the mid-, and long-term effects of video-assisted thoracoscopic thymectomy and transsternal thymectomy in treatment of myasthenia gravis （MG） and to identify the prognostic factors for thymectomy success. Methods 161 patients with non-thymomatous MS, 84 males and 120 females, aged 33, underwent transsternal thymectomy and were followed up for 5 years; and 43 patients with non-thymomatous MS A retrospective , 1 males and 25 females, 21 being aged 〉40 during operation, underwent thoracoscopic thymectomy and were followed up for 3 years. Results The mean operating time of the thoracoscopic group was （132 ±32 ） min minutes, significantly longer than that of the transsternal thymectomy group [ （96 ± 18） min, P =0.000]. Four patients in the transsternal thymectomy group and 41 in the transsternal thymectomy group developed myasthenic crises （ P = 0. 023 ）. The complete stable remission （CSR） rates 1, 2, and 3 years after operation of the thoracoscopic thymectomy group were 34.9% , 41.9% , and 46.5% respectively; and CSR rates 1, 2, 3, and 5 years after operation of the transsternal thymectomy group were 26.7% , 31.7% , 35.4% , and 40.4% respectively, without significant differences between these 2 groups. Conclusion Both thoracoscopic and transsternal approaches to thymectomy in patients with MG are effective in terms of remission. The authors advocate adopting the thoracoscopic approach early.

关 键 词：重症肌无力 胸腔镜 胸腺切除术 

分 类 号：R655[医药卫生—外科学]