Thymus resection with " three holes" operation through subxiphoid and subcostal in the treatment of myasthenia gravis

doi:10.3877/cma.j.issn.2095-8773.2016.02.006

Abstract

Abstract:

Objective

To evaluate the safety and effect of thymus resection with " three holes" operation through subxiphoid and subcostal in the treatment of myasthenia gravis.

Methods

A total of 113 patients with myasthenia gravis undergoing thymus resection with "three holes" operation through subxiphoid and subcostal between December 2013 and July 2015 were enrolled. The general conditions of operation (length of incision, operation time, volume of bleeding, rate of transfer thoracotomy, rate of thymus complete resection, rate of peripheral fat cleaning, length of postoperative hospital stay, and postoperative mortality), pain score and the satisfaction degree of incision were observed.

Results

The length of subxiphoid observation hole was (20±2) mm, the mean operation time was (95.1 ±23.7) min, the mean volume of bleeding was (19.5±9.2) ml (excluding transfer operation), the rate of transfer thoracotomy was 3.53% (4/113), the rate of thymus complete resection was 100%, and the rate of peripheral fat cleaning was (92.37±6.5)%. The mean length of postoperative hospital stay was (3.4 ±1.2) d (without drainage after operation), the postoperative mortality was 0, the mean postoperative pain score was 2.3 ±0.3, and the satisfaction degree of incision was 93.0 ±5.6.

Conclusions

As a new method for expanded thymus resection, the " three holes" operation through subxiphoid and subcostal not only meets the requirement of traditional operation concept of "en bloc" incision principle, but also takes into account the demand of minimally invasive appearance of modern society. This approach is not inferior to the traditional operation in safety and postoperative complications, and can serve as a new method of surgical treatment of myasthenia gravis.

Key words: Three holes operation, Thymus resection, Myasthenia gravis

Qiang Lu, Xiaofei Li, Jinbo Zhao, Juzheng Wang, Zhao Chen, Tianyi Zhang, Yongan Zhou. Thymus resection with " three holes" operation through subxiphoid and subcostal in the treatment of myasthenia gravis[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2016, 03(02): 95-99.

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References 23

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指标			数据
性别(例，男性/女性)			67/46
年龄(±s，岁)			48.3±13.2
病程(±s，个月)			31.5±2.8
MGFA临床分型(例)			?
?	Ⅰ型		16
?	Ⅱa型		18
?	Ⅲa型		17
?	Ⅲb型		29
?	Ⅳa型		18
?	Ⅳb型		15
病理分型(例)			?
?	胸腺增生		11
?	胸腺囊肿		12
?	胸腺上皮灶状增生		16
?	胸腺脂肪瘤		09
?	纵隔鳞癌		02
?	神经内分泌癌		01
?	胸腺瘤		57
?	?	胸腺瘤A	06
?	?	胸腺瘤AB	05
?	?	胸腺瘤B1	09
?	?	胸腺瘤B2	23
?	?	胸腺瘤B3	14
?	其他少见肿瘤		05

指标			数据
性别(例，男性/女性)			67/46
年龄(±s，岁)			48.3±13.2
病程(±s，个月)			31.5±2.8
MGFA临床分型(例)			?
?	Ⅰ型		16
?	Ⅱa型		18
?	Ⅲa型		17
?	Ⅲb型		29
?	Ⅳa型		18
?	Ⅳb型		15
病理分型(例)			?
?	胸腺增生		11
?	胸腺囊肿		12
?	胸腺上皮灶状增生		16
?	胸腺脂肪瘤		09
?	纵隔鳞癌		02
?	神经内分泌癌		01
?	胸腺瘤		57
?	?	胸腺瘤A	06
?	?	胸腺瘤AB	05
?	?	胸腺瘤B1	09
?	?	胸腺瘤B2	23
?	?	胸腺瘤B3	14
?	其他少见肿瘤		05

指标	数据
切口长度(±s，mm)	20±2
手术时间(±s，min)	95.1±23.7
术中出血量(±s，ml)	19.5±9.2
中转开胸率(%)	3.53
胸腺完整切除率(%)	100
周围脂肪清扫率(±s，%)	92.37±6.5
住院时间(±s，d)	3.4±1.2
术后病死率(%)	0
疼痛评分(±s，分)	2.3±0.3
手术切口满意度(±s，分)	93±5.6

指标	数据
切口长度(±s，mm)	20±2
手术时间(±s，min)	95.1±23.7
术中出血量(±s，ml)	19.5±9.2
中转开胸率(%)	3.53
胸腺完整切除率(%)	100
周围脂肪清扫率(±s，%)	92.37±6.5
住院时间(±s，d)	3.4±1.2
术后病死率(%)	0
疼痛评分(±s，分)	2.3±0.3
手术切口满意度(±s，分)	93±5.6

并发症		是否需要处理	例数
暂时性膈神经麻痹		不需	1(0.88)
气胸		不需	3(2.65)
胸腔积液		?	?
?	少量	不需	2(1.76)
?	中量	穿刺抽液	1(0.88)
发热		物理降温	6(5.31)
呼吸衰竭		不需	0(0)
伤口感染或延迟愈合		不需	0(0)
术后危象		不需	0(0)

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