A Clinical Analysis On Three-ports Video-assisted Thoracoscopic Extended Thymectomy In The Treatment Of Myasthenia Gravis With Thymoma

Objective With the development of technology and the continuous progress of multidisciplinary cooperation mode and the diagnosis rate of myasthenia gravis(MG)patients with thymoma is more and more high.To review the perioperative clinical effects of the three-ports video-assisted thoracoscopic extended thymectomy in the surgical treatment of myasthenia gravis(MG)patients with thymoma and the long-term curative effect of short-term postoperative medication.Methods We retrospectively analyzed the clinical data of 50 patients with thymoma with myasthenia gravis who underwent three-ports video-assisted thoracoscopic extended thymectomy(VATET group)from October 2012 to October 2015 in Qilu Hospital of Shandong University hospital,compared with 18 patients with thymoma with myasthenia gravis who underwent the traditional median sternotomy incision surgery(traditional thoracotomy group),the surgery time(Including the time of opening and closing the chest and the time to stop bleeding),total intraoperative blood loss(Including the amount of bleeding when opening and closing the chest and intraoperative thoracic cavity during the operation),postoperative drainage duration and postoperative hospital stay were compared between the two groups.These thymoma with myasthenia gravis patients who underwent three-port video-assisted thoracoscopic extended thymectomy(VATET group)had been subdivided into two groups by Osserman typing:the postoperative patients who taken anticholinesterase drugs in a short time and the postoperative patients who didn’t.Results 68 patients were followed up and the data were obtained.All three-port VATET group are completely thoracoscopic surgery,no conversion to thoracotomy surgery and no postoperative death cases occurred in two groups,after VATET surgery myasthenia crisis occurred in 1 patient,the patient was treated with endotracheal intubation with ventilator assisted ventilation,7 days after removal of the tube,and was discharged on the 16 postoperative day.There were statistical differences in the short-term curative effect between VATET group and traditional thoracotomy group(P<0.05).For the long-term curative effect in anticholinesterase drugs was determined after treatment,the postoperative patients without obvious pulmonary infection,pleural effusion or myasthenia gravis taken anticholinesterase drugs,the postoperative patients who in Osserman type Ⅰ,Ⅱ taken the drugs in 5-7 days after operation,the postoperative patients who in Osserman type Ⅲ taken drugs according to the condition of taking time in advance,about 3-7 days.Type Ⅰ patients were treated with anticholinesterase drugs in short term after operation,complete remission in 1 case,2 cases of drug remission,3 cases improved,1 cases had no change,0 case aggravated;Type Ⅰ patients were treated with anticholinesterase drugs after MG symptoms,complete remission in 1 case,2 cases of drug remission,3 cases improved,5 cases had no change,1 case aggravated.Patients with type Ⅱ or above were treated with anticholinesterase drugs in a short time after operation,complete remission in 1 case,3 cases of drug remission,6 cases improved,3 cases had no change,4 cases aggravated;Patients with type Ⅱ or above were treated with anticholinesterase drugs after the onset of MG symptoms,complete remission in 0 case,2 cases of drug remission.2 cases were improved,6 cases had no change,4 cases aggravated.Compared the group who was treated with anticholinesterase drugs in a short time after operation with the group who was treated with anticholinesterase drugs after the onset of MG symptoms,there were no statistically significant differences in the long-term curative effect of the postoperative patients with type Ⅰ whether to take drugs in a short time(P>0.05).There were statistically significant differences in the long-term curative effect of the postoperative patients with patients with type Ⅱ and above whether to take drugs in a short time(P<0.05).Conclusion All three-ports VATET is safe and effective in the treatment of MG with thymoma.Compared with the traditional median sternotomy incision surgery,it has more advantages than the traditional one,it is a more practical and minimally invasive surgical method.Patients with type ⅡA or above after the three-port video-assisted thoracoscopic extended thymectomy take a short time to take anti cholinesterase drugs can get better long-term efficacy.