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目的:探讨胸腔镜扩大切除胸腺和胸腺瘤治疗重症肌无力的可行性和疗效。方法:回顾性分析2003年7月至2010年12月北京大学深圳医院收治的45例重症肌无力患者的临床资料,均行电视胸腔镜(VATS)下经右胸前侧径路胸腺及胸腺瘤扩大切除术,切除范围包括胸腺瘤在内全胸腺组织到前纵隔和上纵隔所有脂肪组织。结果:45例患者中顺利完成手术44例,1例因术中左无名静脉损伤出血,转为开胸手术:无死亡病例;平均手术时间102 min、平均胸腔引流时间2 d、术后平均住院时间5 d。术后随访3~24个月,总有效率为77.7%(35/45),其中稳定缓解18例、药物缓解17例、无效10例。结论:经右胸前侧径路胸腔镜下胸腺及胸腺瘤扩大切除治疗重症肌无力在技术上可行,具有创伤小、疼痛轻、并发症少、住院时间短、恢复快等优点,但期远期疗效尚待长期随访观察。
Objective: To investigate the feasibility and efficacy of thoracoscopic expansion of thymus and thymoma in the treatment of myasthenia gravis. Methods: The clinical data of 45 patients with myasthenia gravis treated in Peking University Shenzhen Hospital from July 2003 to December 2010 were retrospectively analyzed. All patients underwent VATS thoracic and thymoma enlargement Excision, resection range, including thymoma in the whole thymus tissue to the anterior mediastinum and the mediastinum all fatty tissue. Results: Forty-four patients were successfully completed in 45 patients. One patient died of left anterior descending venous insufficiency due to intraoperative left venous thrombosis. There were no deaths. The average operation time was 102 min and the average chest drainage time was 2 d. The average postoperative hospital stay Time 5 d. The patients were followed up for 3 to 24 months. The total effective rate was 77.7% (35/45), of which 18 were stable and stable, 17 were relieved and 10 were ineffective. Conclusion: It is technically feasible to expand myectomy for thymus and thymoma through thoracoscopic thoracoscopic thoracoscopic thoracoscopic surgery. It has the advantages of less trauma, less pain, less complications, shorter hospital stay and faster recovery. However, the long-term Long-term follow-up effect remains to be observed.