| 作者 |
Torng-Sen Lin, Hsing-Yuan Fang, Chung-Yow Lai, Ching-Yuan Cheng, Chen Tay Hou, Kun-Jou Hsieh, Chin-Yen Wu, Yea-Ling Ting, Ching-Ling Chang |
| 摘要 |
Video-assisted thoracoscopic surgery (VATS) provides a new approach to thymectomy for treating patients with myasthenia gravis. We enrolled a total of 20 patients with myasthenia gravis in this study. Preoperative Osserman's classification revealed one patient was in class I, five patients were in class IIA, 11 patients were in calss IIB, one patient was in class III, and two patients were in class IV. During operation, all were placed in supine positions in the 30 degree left lateral decubitus postion under double-lumen intubated anesthesia. Usually three 1 cm incision wounds over infraaxillary line at the 3rd, 5th and 6th intercostal spaces were used. Sometimes the creation of another 2 cm incision wound at the right 2nd intercostal space just lateral to the sternum was useful. Both the thymic gland tissue and anterior mediastinal adipose tissue can be harvested via VATS. All procedures were performed using right VATS approaches without conversion. The average operating time was 2.8 hours (range, 2.5 to 5 hours). Most patients were extubated in the operating room or recovery room. Postoperative prolonged ventilator support was needed in one patient with concurrent pancytopenia. The final pathologic results included, two had encapsulted stage I thymoma, 17 had hyperplastic thymus, and one had atrophic thymus. Surgical morbidity was minimal. None of the 20 patients died during operation. The average hospital stay was 5 days (range, 3-14 days). Ninety percent of the patients were discharged within one week of operation. After a mean follow-up of 24 months (rang, 15 to 39 months), six (30%) patients were in complete remission, four (20%)patients were asymptomatic and on decresed amounts of medication, eight (40%)were symptomatic with improvement and on decreased amounts of medication, and two (10%) had no change of symptoms. In total, 18 (90%) patients obtained benefits from VATT. We concluded that complete thymectomy can be achieved using VATT and recommend VATT as a safe and effective method for treating myasthenia gravis. |
