| ObjectiveThis article mainly studies the surgical treatment of mediastinal mass with myasthenia gravis,to compare the postoperative indexes of total thymectomy and mediastinal fat removal by three surgical methods:robot-assisted thoracoscopic surgery(RATS),video-assisted thoracoscopic surgery(VATS)and open access by total median sternotomy.And to explore the trend of the methods in the surgical treatment of mediastinal mass with myasthenia gravis in the future.MethodsThe clinical data of patients undergoing total thvmectomy and mediastinal fat removal by RATS,VATS and open access by total median sternotomy were performed retrospectively from January 2010 to December 2017 in the General Hospital of North Theater Commend.Patients were divided into Group A(robot-assisted thoracoscopic surgery RATS);Group B(video assisted thoracoscopic surgery VATS).Group C(open accession by total median sternotomy),which are compared from the aspect as the gender distribution,intraoperative blood loss,operating time,postoperative retained chest tube days,postoperative hospital stay.Osserman classification of myasthenia gravis,postoperative myasthenic remission rate and etc.ResultA total of 53 patients were enrolled in this study,including 22 in group A.12 in group B and 19 in group C.The patient’s age distribution was 17-73 years old.Gender distribution:29 males and 24 females.Comparison of operation time:group A(90.8±9.2min)was shorter than group B(131.3±10.5min)and group C(159.5±15.9min),and the difference was statistically significant.Comparison of intraoperative blood loss:compared with group B(105.0±22.6ml)and group C(231.6±32.7ml),group A(18.0±4.2ml)had less blood loss,and the difference was statistically significant.Comparison of drainage volume on the first day after surgery:compared with group B(224.2±20.5ml)and group C(362.6±59.8ml).group A(74.1±19.2ml)had less drainage volume.and the data was statistically significant.Comparison of thoracic drainage tube indwelling time:compared with group B(4.4±0.5d)and group C(5.7±2.3d),group A(2.2±0.7d)had shorter indwelling time,and the difference was statistically significant.Postoperative hospitalization days:group A(5.3±0.4d)was discharged earlier than group C(16.7±3.7d).and the difference was statistically significant,and group B(10.3±1.2)showed no statistical significance compared with group A and C.Postoperative myasthenia remission rate:group A(88.9%)was higher than group B(75.0%)and group C(76.9%),but there was no significant statistical difference.None of the patients died perioperatively.One case of group B thoracoscopy transit to open accession due to the intraoperative injury of the left brachiocephalic vein.One of the patients in the C group suffered from myasthenia gravis crisis after surgery who was discharged healthily after positive treatment and improvement.ConclusionThe traditional open access by total median sternotomy has good visual field,so the operation is direct and convenient.However,the incision and blood loss volume are large,and the postoperative recovery time of patients is long.In the VATS group,the surgical incision was small,and the patients recovered quickly.But because of limited instruments,the remission rate was slightly lower than the other two groups.In addition to the advantages of minimally invasive of VATS.RATS is superior in the flexibility and visual acuity of equipment operation.Therefore,in this study,patients with myasthenia gravis combined with thymus mass who underwent mediastinal mass enlargement resection by RATS were superior to the other two groups in terms of some indices during the perioperative period and short-term myasthenia remission rate after the operation.The data,though,need to be confirmed by iong-term results and a large number of paired trials.However,it is undeniable that robotic surgery will definitely lead the development of minimally invasive surgery in the future. |
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