| Objective:To compared the clinical out comes of VATSt hymectomy with conventional transsternal(TS) approach in treating myasthenia gravis.Methods: A total of 76 patients who underwent either VATS(n=21) or transsternal(TS) thymectomy(n=55) for MG were reviewed retrospectively between January 2011 and November 2014. Perioperative and long-term outcome were compared. We also performed a meta-analysis to evaluate the safety and efficacy of VATS compared with TS in the treatment of MG.Results:1. The operative time in the VATS group was significantly longer than that in the open group(127.9±35.92 min vs. 96.8±26.08 min,P=0.001), the estimated blood loss in the VATS group was significantly less than that in the open group(51.2±23.34 m L vs. 122.3±111.51 m L,P=0.005). However, no significant association were found in ventilator support time(18.8±42.70 h vs. 19.1±41.93 h, P=0.84), ICU stay(36.5±66.93 h vs. 41.0±85.23,P=0.83), mean total drainage(349.3±271.29 m L vs. 422.0±277.32 m L,P=0.31), chest tube remove time(3.0±0.97 d vs. 3.3±0.90 d,P=0.27), hospital stay(6.4±5.28 d vs. 8.2±4.68 d,P=0.15), the use of painkiller(33.3% vs. 52.7%,P=0.31), and complication(19.0% vs. 27.3%,P=0.46) between two studies. There was no significant difference between the VATS and TS regarding CSR(23.8% vs. 27.3%,P=0.76).2. In meta-analysis, 21 studies including 2463 patients were included in our analysis. Although there was a significant difference in the operating time in favor of TS(WMD: 25.99min; 95% CI: 10.53, 41.45; P=0.001); patients having VATS might benefit from significantly fewer less blood loss(WMD:-82.24 m L; 95% CI:-107.57,-56.92; P<0.001), ventilator support time(WMD:-0.42h; 95% CI:-0.79,-0.05; P=0.03), mean total drainage(WMD:-93.81 m L; 95% CI:-141.69,-45.92; P<0.001), ICU stay(WMD:-0.61d; 95% CI:-0.95,-0.27; P<0.001), hospital stay(WMD:-4.15d; 95% CI:-6.16,-2.13; P<0.001), postoperative MG crisis(OR=0.40, 95% CI=0.25-0.63, P<0.001) and complication(OR: 0.66; 95% CI: 0.46, 0.94; P=0.02). There was no significant difference between the VATS and TS regarding CSR(OR=0.97, 95% CI=0.78-1.21, P=0.80).Conclusions: This study supports the use of VATS for the treatment of MG showed better short-term outcome(perioperative parameter, postoperative MG crisis and complication) when compared to TS. The long term CSR appear similar between two approaches. |
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