Clinical analysis of trans-subxiphoid thoracoscopic approach for performing extended thymectomy in patients with myasthenia gravis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 周一凡 , 钟永泷 , 林辉 , 李香伟 , 温昭科 , 龙小毛

广西壮族自治区人民医院心胸外科（南宁 530021）;

Corresponding author：

周一凡, Email: richbeijing@163.com

Keywords：

重症肌无力; 胸腔镜; 剑突入路; 胸腺切除

DOI：

10.7507/1007-4848.201604058

Video：

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目的探讨结合肋缘下切口的剑突入路胸腔镜胸腺扩大切除治疗重症肌无力的手术安全性与临床疗效。方法回顾性分析 2015 年 10 月至 2016 年 4 月期间我院心胸外科收治的 23 例重症肌无力合并胸腺疾病患者的临床资料。其中男 8 例、女 15 例，年龄 11～70（40.70±17.31）岁。所有患者采用经剑突入路胸腔镜胸腺扩大切除手术。结果所有手术均成功，无中转开胸或延长手术切口长度患者。患者切口长度平均（2.76±0.40）cm，手术时间平均（138.4±35.4）min，术中出血量平均（35.2±28.6）ml，术后呼吸机辅助时间平均（13.40±9.84）h，采用延迟拔管 1 例，术后并发症 2 例，其中少量胸腔积液 1 例、肺炎 1 例。术后疼痛视觉模拟（VAS）评分平均 2.77 分。结论剑突入路胸腔镜胸腺扩大切除技术是安全可行的手术方式，具有容易操作、清扫彻底、手术创伤小、恢复快、美容效果好等优点，值得深入研究及进一步推广。

Citation： 周一凡, 钟永泷, 林辉, 李香伟, 温昭科, 龙小毛. Clinical analysis of trans-subxiphoid thoracoscopic approach for performing extended thymectomy in patients with myasthenia gravis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(4): 318-320. doi: 10.7507/1007-4848.201604058 Copy

1.	Raza A, Woo E.Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg, 2016, 5(1): 33-37.
2.	Sugarbaker DJ. Thoracoscopy in the management of anterior mediastinal masses. Ann Thorac Surg, 1993, 56(3): 653-656.
3.	张毅, 支修益, 许庆生, 等. 电视胸腔镜下扩大胸腺切除治疗重症肌无力. 中国胸心血管外科临床杂志, 2008, 15(6): 473-474.
4.	Xie A, Tjahjono R, Phan K, et al. Video-assisted thoracoscopic surgery versus open thymectomy for thymoma: a systematic review. Ann Cardiothorac Surg, 2015, 4(6): 495-508.
5.	Hsu CP, Chuang CY, Hsu NY, et al. Subxiphoid approach for video-assisted thoracoscopic extended thymectomy in treating myasthenia gravis. Interact Cardiovasc Thorac Surg, 2002, 1(1): 4-8.
6.	周一凡, 贺榜福, 梁胜景, 等. 40 例胸腺瘤合并重症肌无力的外科治疗. 中国医药指南, 2012, 10(3): 32-33.
7.	Donahoe L, Keshavjee S. Video-assisted transcervical thymectomy for myasthenia gravis. Ann Cardiothorac Surg, 2015, 4(6): 561-563.
8.	胡牧, 张毅, 支修益. 电视胸腔镜下扩大胸腺切除治疗重症肌无力. 中国胸心血管外科临床杂志, 2008, 15(6): 473-474.
9.	Suda T, Tochii D, Tochii S, et al. Trans-subxiphoid robotic thymectomy. Interact Cardiovasc Thorac Surg, 2015, 20(5): 669-671.
10.	张国瑜, 张双林, 张清勇, 等. 经剑突下单孔胸腔镜治疗双侧胸部疾病. 中华实验外科杂志, 2015, 32(10): 2581-2582.
11.	Suda T, Ashikari S, Tochii D, et al. Dual-port thymectomy using subxiphoid approach. Gen Thorac Cardiovasc Surg, 2014, 62(9): 570-572.
12.	Suda T, Hachimaru A, Tochii D, et al. Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: initial resultsdagger. Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i54-i58.

1. Raza A, Woo E.Video-assisted thoracoscopic surgery versus sternotomy in thymectomy for thymoma and myasthenia gravis. Ann Cardiothorac Surg, 2016, 5(1): 33-37.
2. Sugarbaker DJ. Thoracoscopy in the management of anterior mediastinal masses. Ann Thorac Surg, 1993, 56(3): 653-656.
3. 张毅, 支修益, 许庆生, 等. 电视胸腔镜下扩大胸腺切除治疗重症肌无力. 中国胸心血管外科临床杂志, 2008, 15(6): 473-474.
4. Xie A, Tjahjono R, Phan K, et al. Video-assisted thoracoscopic surgery versus open thymectomy for thymoma: a systematic review. Ann Cardiothorac Surg, 2015, 4(6): 495-508.
5. Hsu CP, Chuang CY, Hsu NY, et al. Subxiphoid approach for video-assisted thoracoscopic extended thymectomy in treating myasthenia gravis. Interact Cardiovasc Thorac Surg, 2002, 1(1): 4-8.
6. 周一凡, 贺榜福, 梁胜景, 等. 40 例胸腺瘤合并重症肌无力的外科治疗. 中国医药指南, 2012, 10(3): 32-33.
7. Donahoe L, Keshavjee S. Video-assisted transcervical thymectomy for myasthenia gravis. Ann Cardiothorac Surg, 2015, 4(6): 561-563.
8. 胡牧, 张毅, 支修益. 电视胸腔镜下扩大胸腺切除治疗重症肌无力. 中国胸心血管外科临床杂志, 2008, 15(6): 473-474.
9. Suda T, Tochii D, Tochii S, et al. Trans-subxiphoid robotic thymectomy. Interact Cardiovasc Thorac Surg, 2015, 20(5): 669-671.
10. 张国瑜, 张双林, 张清勇, 等. 经剑突下单孔胸腔镜治疗双侧胸部疾病. 中华实验外科杂志, 2015, 32(10): 2581-2582.
11. Suda T, Ashikari S, Tochii D, et al. Dual-port thymectomy using subxiphoid approach. Gen Thorac Cardiovasc Surg, 2014, 62(9): 570-572.
12. Suda T, Hachimaru A, Tochii D, et al. Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: initial resultsdagger. Eur J Cardiothorac Surg, 2016, 49(Suppl 1): i54-i58.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical analysis of trans-subxiphoid thoracoscopic approach for performing extended thymectomy in patients with myasthenia gravis

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