| Objective: To evaluate the effect of thoracoscopic surgery and median thoracotomy in the treatment of thymus myopathy with myasthenia gravis(MG).METHODS: MG patients who were treated in thoracic surgery from the First Affiliated Hospital of Guangxi Medical University from January 2013 to August 2017 were selected to use Video-assisted thoracic surgeries(VAST)to complete thymectomy for MG with thymoma.Fifteen patients were observed in the observation group.In the same period,21 patients with enlarged thoracotomy were used as control group.All patients can tolerate general anesthesia and single lung ventilation after preoperative evaluation.Patients with poor lung function receive preoperative respiratory tract preparations.Drug users are adjusted to the optimal dose of the drug,so that the patient can handle the best state and is suitable for comprehensive analysis.Endoscopic surgery.By comparing the operation time,surgical blood loss,postoperative complications,postoperative catheterization time,postoperative time to hospital discharge,pain level,postoperative symptom remission and other indicators,the efficacy of the two were compared.Results: 1.36 cases were followed up and the complete datawere obtained.The patients in the thoracoscopic group had no conversion to open thoracotomy.During the hospitalization period,both groups had no surgery and died after surgery.There was one case of myasthenia gravis in the thoracoscopic group and six cases of myasthenia gravis in the median thoracotomy group.After combined treatment of ventilation and internal medicine,all patients were able to recover and the condition was stable and discharged.There was no statistical difference between the two groups(P>0.05).2.Compared with the thoracoscopic group and the open group,the operation time of the open group was shorter than that of the thoracoscope group(P<0.05).Compared with the open group,the intraoperative blood loss,postoperative tube length,postoperative hospital stay were compared between the thoracoscopic group and the open group.Less postoperative pain duration(P<0.05)In postoperative pathology of 3.36 patients,thoracoscopy group included 1 patient with type A thymoma and 3 patients with type AB thymoma;11 patients with type B thymoma(including There were 5 cases of B1,4 cases of B2,and 2 cases of B3).In the traditional thoracotomy group: 0 cases of type A thymoma and 5cases of type AB thymoma;16 cases of type B thymoma(including 5 cases of B1,B2 10 case,B3 1 case).There was no statistical difference between the two groups(P>0.05).4.The thoracoscopic group achieved complete remission in 4cases and partial remission in 10 cases.The effective rate was 93.33%.There was 1 patient with no improvement in the performance of myasthenia after surgery,and there was a thymoma metastasis.There were 4 cases of complete remission in the open group and 16 cases of partial remission.For example,the effective rate was 95.24%.One patient died of myasthenia gravis crises about one month after surgery.Comparison of the long-term outcomes between the two groups During follow-up,3 patients reported a myasthenia gravis oraggravation of myasthenia gravis at 1 month after surgery,including 2 in the open group and 1 in the thoracoscopic group.However,after treatment,the current condition is less than before surgery.The results of Osserman classification,Masaoka staging and WHO histopathologic typing had no statistical significance(P>0.05).Conclusion: Thoracoscopic enlargement of the thymus is safe,reliable,and practical,and it is an effective method to treat MG.Video-assisted video-assisted thoracoscopic surgery is a minimally invasive and practical surgical procedure with minimal trauma and short postoperative pain duration compared with conventional mid-thoracic thymus enlargement resection. |
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