ABSTRACT
Objective To investigate curative effects and prognostic factors of video-assisted thoracoscopic extended thymectomy ( VATET ) for nonthymomatous myasthenia gravis ( NTMG ) . Methods Clinical records of 43 patients with an established diagnosis of NTMG who underwent VATET from December 2009 to September 2014 were reviewed. Three-port thoracoscopic right thymectomy with resection of fat tissue in anterior mediastinum was conducted.The curative effects and prognostic factors were evaluated and analyzed with the Monden standard. Results The VATET was successfully completed in all the 43 patients.The operation time was 75-240 min (mean, 115.4 min).The intraoperative blood loss was 10-200 ml (mean, 42.2 ml). No peri-operative death occurred.Follow-ups for 4 -60 months ( mean, 36.2 months) showed 12 cases of remission, 18 cases of improvement, 10 cases of unchanged disease, and 3 cases of deterioration.The effective rate was 69.8% (30/43).Multivariate logistic regression analysis showed that pathological type of thymic hyperplasia was the independent risk factor for NTMG postoperative outcomes (β=0.921,95%CI:1.866-2.811, P=0.000). Conclusion Video-assisted thoracoscopic extended thymectomy is effective in most myasthenia gravis patients.
ABSTRACT
Objective To investigate the perioperative management and video-assisted thoraco-scopic (VATS) extended thymectomy for myasthenia gravis ( MG ). Methods A total of 102 patients who received extended thymectomy for MG from June 2000 to August 2007 were divided into 2 groups by operative approach: 51 in the VATS group and 51 in the full median sternotomy group. The clinical features, including operation time, operation blood loss, post-operative drainage, inci-dence of crisis, hospital stay, and the 1-year total effective rate after the operation were compared. Complications were treated exactly and cholinesterase inhibitors were applied to control the symptom of MG before the operation. The whole thoracic gland and fat in the anterior mediastinum were removed. Steroid, cholinesterase inhibitors and plasmapheresis were used to prevent and cure masthemic crisis after the operation. Results No patients died in the operation and hospitalization. There was no sig-nificant difference in the operation time [(128.14±34.82) min vs. (130.46±28.71) min] and the 1-year total effective rate after the operation (85.8% vs. 87.2% )in the 2 groups(P>0.05).The operation blood loss, postoperative drainage, incidence of crisis, and postoperative hospital stay in the median sternotomy group were higher or longer than those in the VATS group [(93.77±21.64) mL vs. (45.42±10.96)mL,P<0.05; (174.65±21.64)mL vs. (101.33±28.76) mL,P <0.01;7.84% vs. 1.96%, P<0.05;(14.23±3.17)d vs. (8.37±1.18)d, P<0.05)]. Conclusion VATS extended thymectomy for myasthenia gravis is safe, less invasive and effective. Preoperative preparation and the perioperative managemant can decrease the incidence of crisis. The plasmapheresis is the key of curing masthemic crisis.