胸腔镜下胸腺扩大切除术治疗眼肌型重症肌无力  

Video-assisted Thoracoscopic Extended Thymectomy for the Treatment of Ocular Myasthenia Gravis

作　　者：于涛[1] 马山[1] 李建业[2] 蒋俭[1] 张云峰[1] 余震[1] 景筠[2] 

机构地区：[1]首都医科大学附属北京同仁医院胸外科,北京100730 [2]首都医科大学附属北京同仁医院神经内科,北京100730

出　　处：《医学临床研究》2012年第12期2286-2288,共3页Journal of Clinical Research

摘　　要：[目的]探讨胸腔镜胸腺扩大切除术治疗眼肌型重症肌无力（0MG）的可行性和术后疗效。[方法]对本院采用胸腔镜胸腺切除术治疗OMG患者138例的临床资料进行研究分析，138例患者术中除完整切除胸腺外，同时彻底清除前纵隔区域脂肪组织。术后按美国重症肌无力基金会评分法进行疗效评定。[结果]全组137例手术在电视胸腔镜下完成，1例中转开胸，平均手术时间（122±21．8）min。术后无肌无力危象发生。术后病理学诊断：胸腺增生84例，胸腺萎缩31例，胸腺瘤13例，正常胸腺9例，胸腺脂肪瘤1例，切除胸腺平均重量43．9g，清除纵隔脂肪平均重量27．8g。所有患者均痊愈出院。术后随访观察≥2年，观察期终末的完全缓解率44．9％（62／138），有效率达83．3％（115／138）。[结论]胸腔镜下胸腺扩大切除术治疗0MG能取得较为理想的治疗效果。[Objective] To explore the feasibility and efficacy of video-assisted thoracoscopic extended thymectomy for the treatment of ocular myasthenia gravis（OMG）. [Methods] Clinical data of 138 patients with OMG undergoing video-assisted thoracoscopic thymectomy in our hospital were analyzed retrospectively. All 138 patients underwent the total thymectomy and complete removal of adipose tissue in anterior mediasti- num. The efficacy was assessed by using Myasthenia Gravis Foundation of America（MGFA） score aster operation. [Results] The operation was completed for 137 patients under video-assisted thoracoscope. One patient turned to thoracotomy. The mean operation time was 122±21.8 minutes. No myasthenia crisis occurred after operation. The pathological diagnosis showed 84 patients were thymus hyperplasia, 13 patients were thymic atrophy, and 13 patients were thymic tumor, and 9 patients were normal thymus, and one patient was thymo- lipoma. The mean removal weight of thymus tissue and adipose tissue in mediastinum was 43.9g and 27.8g, respectively. All these patients were cured and followed up for more than 2 years. The complete remission rate of endpoint was 44.9% （62/138）, and the effective rate reached to 83.3 % （115/138）. [Conclusion]Video-assisted thoracoscopic thymectomy is an ideal method for the treatment of OMG.

关 键 词：眼肌麻痹 外科学 胸腺切除术 方法 胸腔镜检查 

分 类 号：R277.761[医药卫生—中医学]