Comparative study of video-assisted thoracoscopic extended thymectomy by subxiphoid-costal margin approach versus right intercostal approach in treating myasthenia gravis / 中华老年医学杂志

ABSTRACT

Objective:To compare the characteristics and therapeutic effects of video-assisted thoracoscopic(VATS)extended thymectomy by subxiphoid-costal margin approach versus right intercostal approach for the treatment of myasthenia gravis(MG).Methods:A retrospective analysis was conducted on 230 non-thymomatous MG patients undergone VATS extended thymectomy in our department from August 2015 to August 2019.According to the operation approach and method, patients were divided into two groups the subxiphod-costal margin approach group(n=102)and the right intercostal approach group(n=128).Results:Intraoperative blood loss and the postoperative drainage were less in the subxiphod-costal margin approach group than in the right intercostal approach group[(30.3±25.2) ml vs. (45.1±30.6) ml, (178.6±90.5) ml vs.(205.4±87.6) ml, t=-3.935 and -2.27, P=0.003 and 0.024)]. Postoperative pain degree was lower in the subxiphod-costal margin approach group than in the right intercostal approach group [the Numerical Rating Scale(NSR)scores 3.1±1.0 vs. 4.6±1.5, t=-8.677, P=0.001]. A difference in incidence rate of pore malunion also existed between the subxiphod-costal margin approach group and the right intercostal approach group, but it had no statistical significance(1/102 vs. 7/128, χ2=2.200, P=0.138). The complete remission rate and the overall effectiveness rate had no significant difference between the two groups(29.6% vs.32.4%, 85.7% vs. 84.7%, χ2=0.196 and 0.044, P=0.658 and 0.834). Conclusions:VATS extended thymectomy by subxiphoid-costal margin approach shows excellent safety and effectiveness in treating MG.It has advantages of low trauma and complications, and is particularly suited for elderly and female MG patients who are unable to receive double-lumen endotracheal intubation, are intolerant to one-lung ventilation or have pulmonary insufficiency.