电视胸腔镜手术治疗非胸腺瘤重症肌无力的中期疗效和生活质量  

Mid-term Efficacy and Quality of Life after Video-assisted Thoracoscopic Extended Thymectomy for Nonthymomatous Myasthenia Gravis

作　　者：赵桂彬[1] 崔键[1] 郭庆凤[1] 刘成[1] 闫宇博[1] 董庆[1] 张凯[1] 

机构地区：[1]哈尔滨医科大学第四临床医学院胸外科,哈尔滨150001

出　　处：《中国微创外科杂志》2010年第12期1088-1090,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的评估电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）治疗非胸腺瘤重症肌无力（nonthymomatous myasthenia gravis,NTMG）的中期疗效和生活质量,以合理选择手术方式。方法 2003年5月-2006年6月施行VATS胸腺扩大切除术治疗26例NTMG,术后3年随访采用术后MG相关症状变化DeFilippi分级和美国重症肌无力基金会MG评分（MGFA评分）评估术后疗效;采用欧洲癌症研究和治疗组织（European Organization for Research and Treatment ofCancer,EORTC）生活质量问卷（quality-of-life questionnaire,QLQ）评分评估术后生活质量。结果 26例手术顺利,无肌无力危象发生。术后1例并发肺炎,无围手术期死亡。术后3年随访时MG相关症状变化DeFilippi分级,1-3级26例,4-5级0例,总有效率为100%;MGFA评分（8.1±1.6）分优于术前（14.2±2.9）分（t=-9.391,P=0.000）;EORTC-QLQ6项（包括躯体、角色、认知、情绪、社会、总生活质量）评分术后均高于术前,除社会功能评分外,差异均有统计学意义（P〈0.05）。结论 VATS胸腺扩大切除治疗NTMG,MG症状改善率高,生活质量好,术后并发症少,是治疗NTMG的一种有效方法,具有良好临床应用前景。Objective To investigate the value of video-assisted thoracoscopic surgery（VATS）for extensive thymectomy in the treatment of nonthymomatous myasthenia gravis（NTMG）,and the mid-term efficacy and quality of life after the procedure.Methods A retrospective analysis on 26 cases of NTMG,who were preoperatively confirmed to be NTMG from May 2003 to June 2006 with VATS;clinical efficacy was measured by DeFilippi classification for changes in myasthenia gravis-associated symptoms and MGFA score,quality of life was studied by modified European Organization for Research and Treatment of Cancer（EORTC）Quality-of-life Questionnaire（QLQ）at 3-year of the follow-up.Results The operation was completed in all the 26 cases without leading to myasthenic crisis.One patient developed postoperative pneumonia,but no perioperative death occurred.At 3-year of the follow-up,MG symptoms was improved according to the DeFilippi score（1-3 level,26 cases;4-5 level 0 case）,and MGFA score was increased significantly compared to pre-operation（8.1±1.6 vs 14.2±2.9,t=-9.391,P=0.000）;meanwhile,EORTC-QLQ showed improvement in the six items（Physical,Role,Cognitive,Emotional,Social,and Global ability,P0.05 except for the social ability）.Conclusions Extended thymectomy by VATS is an effective and promising treatment for NTMG,for its superiority in improving MG symptoms and quality of life,and avoiding surgical complications.

关 键 词：电视胸腔镜手术 胸腺扩大切除术 重症肌无力 生活质量 

分 类 号：R655[医药卫生—外科学] R746.1[医药卫生—临床医学]