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題名 | Video-Assisted Thoracoscopic Thymectomy for Myasthenia Gravis: Analysis of 20 Cases=胸腔鏡胸腺摘除手術治療重症肌無力症之經驗:20例病例分析 |
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作者 | 林同森; 方信元; 賴重佑; 鄭清源; 侯振泰; 謝坤洲; 吳金燕; 丁雅鈴; 張靖苓; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 33:3 民89.05-06 |
頁次 | 頁112-118 |
分類號 | 416.22 |
關鍵詞 | 影像胸腔鏡手術; 重症肌無力症; Myasthenia gravis; Video-assisted thoracoscopic surgery; |
語文 | 英文(English) |
中文摘要 | 胸腺摘除手術治療重症肌無力症已行之多年,隨著胸腔鏡手術的進步,我們從民國八十六年一月 到八十七年十月共收集二十位罹患重症肌無力症之患者。經電視影像輔助施行胸腔鏡胸腺摘除手術,其中有5位是男性,15位是女性,平均年齡是32歲 (從11到55歲)。手術前的症狀依照Osserman之分類,有l例是第一期、有5例是第二A期、5例是第二B期、1例第三期、2例第四期。我們手術前不做例行之血漿置換術。手術時採平躺但須左側傾斜三十度,原則上在第三、五、六肋間作一個壹公分的刀口即可施行胸腺摘除術,但有時增加一個位於第二肋間的兩公分刀口可加速手術之進行。平均手術時間需要2.8小時(從2.5到5小時) ,取下之胸腺平均重量32公克(19到60公克),平均住院天數5天,沒有案例需要轉換成開胸手術,沒有手術在死亡病例。經過平均一年半之追蹤期(從13到35個月),依照DeFilippi之分類,有百分之三十的病人獲得完全痊癒,百分之三十的病人進有任何症狀,但仍需要服用少量藥物,百分之四十的病人症狀改善,但仍需要藥物幫助,只有百分之十的病人症狀沒何明顯進步,但整體上,百分之九十的病人經由手術獲得益處,所以我們建議利用胸腔鏡施行胸腺摘除治療重症肌無力症是一個安全而且有效的治療方法,但是長期失規模的病例分析及追蹤是往後重要的課題。 |
英文摘要 | Video-assisted thoracoscopic surgey (VATS)provides a new approach to thymectomy for treating patients with myasthenia gravis. We present our experience in video-assisted thoracoscopic thymectomy (VATT) for myasthenia gravis. We enrooled a total of 20 patients with myasthenia gravis in this study. Preoperative Osserman's classification recealed one patient was in class I, five patients were in class IIA, 11 patients were in class IIB, one patient was in class III, and two patients were in class IV. During operation, all were placed in supine positions in the 30 degree left lateral decubitus position under double-lumen intubated anesthesia. Usually three 1 cm incision wounds over infraasillary line at the 3rd, 5th and 6th intercostal spaces were used. Sometimes, the creation of another 2 cm incision wound at the tight 2nd intercostal space just lateral to the sternum was useful. Both the thymic gland tissue and anterior mediastinal adipose tissue can be harvested via VATS. All procedures were performed using right VATS approaches without conversion. The average operating time was 2.8 hours (range, 2.5 to 5 hours). Most patients were extubated in the operating room or recovery room. Postoperative prolonged ventilator support was needed in one patient with concurent pancytopenia. The final pathologic results included, two had encapsulted stage I thumoma, 17 had hyperplastic thymus, and one had atrophic thymus. Surgical mornidity was minimal. None of the 20 patients died during operation. The average hospital stay was 5 days (range, 3-14 days). Ninety percent of the patients were discharged within one week of operation. After a mean follow-up of 24 months (range, 15 to 39 months), six (30%) patients were in complete remission, four (20%) patients were asymptomatic and on decreased amounts of medication, eight(40%) were symptomatic with improvement and on decreased amounts of medication, and two (10%) had no change of symptoms. In total, 18 (90%) patients obtained benefits from VATT. We concluded that complete thymectomy can be achieved using VATT and recommend VATT as a safe and effective method for treating myasthenia gravis. |
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