Objective To compare the different surgical treatment methods of thymoma combined with myasthenia gravis (MG), and to discuss the clinical effectiveness of thoracoscopic combined mediastinoscopic extended thymectomy. Methods We retrospectively analyzed the clinical data of 58 patients of thymoma combined with myasthenia gravis in Northern Jiangsu People's Hospital between 2011 and 2016 year. According to the operation method, the patients were divided into three groups including a group A for thoracoscopic thymectomy (n=32), a group B for thoracoscopic combined mediastinoscopic thymectomy (n=15), and a group C for transsternal thymectomy (n=11). The clinical effects were observed and compared. Results In the group A and the group B, the bleeding volume, postoperative hospital stay and other complications were significantly lower than those in the group C with statistical differences (P<0.05). The incidence of myasthenic crisis in the group B (6.7%) was less than that in the group C (36.4 %), but the difference was not statistically different (P=0.058). The operation time of the three groups was 122.0 ± 39.4 min, 130.3 ± 42.5 min, and 142.3 ± 40.8 min respectively with no statistical difference between the two groups (P>0.05). The rate of dissection grade in the group B (grade 1, 12 patients, 80%) was significantly greater than that in the group A (grade 1, 14 patients, 43.8%,P<0.05). The effective rate of the group A, the group B, the group C was 84.4%, 93.3% and 90.9%, respectively with no statistical difference between groups (P>0.05). Conclusion The thoracoscopy combined mediastinoscopic thymectomy not only has the advantages of less trauma, quicker recovery and fewer complications, but also can more thoroughly clean the thymus and adipose tissue, which can achieve the same therapeutic effect as the transsternal thymectomy.
ObjectiveTo compare the efficacy and safety of video-assisted thoracoscopic surgery (VATS) thymectomy for the treatment of thymoma through subxiphoid uniportal approach using double sternum retractors, and subxiphoid and subcostal arch approach. Methods We retrospectively analyzed the clinical data of the patients diagnosed with thymoma who underwent VATS thymectomy from June 2023 to June 2024 in West China Hospital. Patients were categorized based on the surgical approach into two groups: a subxiphoid uniportal VATS thymectomy (SUVT) group and a subxiphoid and subcostal arch VATS thymectomy (SASAT) group. Comparisons were made between the two groups regarding surgical duration, intraoperative blood loss, postoperative drainage, thymoma size and location, and postoperative pain assessed using the visual analogue scale (VAS). ResultsThe SUVT group consisted of 20 patients, including 11 males and 9 females, with an average age of (51.5±14.3) years. The SASAT group comprised 40 patients, including 26 males and 14 females, with an average age of (50.0±13.0) years. Compared to the SASAT group, the SUVT group had significantly larger thymomas [ (5.9±2.7) cm vs. (4.2±2.1) cm, P=0.010] and a higher proportion of neoplasms located in the superior mediastinum (30.0% vs. 2.5%, P=0.007). Additionally, the VAS pain scores on postoperative days 3, 7, and 30 were significantly lower in the SUVT group compared to the SASAT group (P<0.05). There were no statistical differences between the two groups in demographic characteristics, operative time, intraoperative blood loss, duration and volume of postoperative drainage, length of postoperative hospital stay, or the VAS pain score on the first postoperative day. Conclusion SUVT using double sternum retractors significantly reduces postoperative pain and provides superior efficacy in the resection of larger thymomas or those situated in the superior mediastinum.
ObjectiveTo investigate the safety, feasibility and advantages of subxiphoid uni-portal thoracoscopic thymectomy.MethodsClinical data of 65 patients undergoing subxiphoid uni-portal thoracoscopic thymectomy in our hospital from September 2018 to March 2019 were retrospectively analyzed. They were treated as a subxiphoid surgery group, including 36 males and 29 females, aged 49.5 (29-71) years. The incision with the length of about 3 cm was located approximately 1 cm under the xiphoid process. From January 2016 to December 2017, 65 patients received intercostal uni-portal thoracoscopic thymectomy, who were treated as a control group, including 38 males and 27 females, aged 48.9 (33-67) years. All patients who were clinically diagnosed with thymic tumor before surgery were treated with total thymectomy. After surgery, expectoration and analgesia were used.ResultsThere was no statistically significant difference in general clinical data, lesion size, intraoperative blood loss, postoperative catheterization time, postoperative hospital stay and postoperative pathology between the two groups. All operations were successfully completed, and the patients in both groups recovered uneventfully after surgery. Visual analogue scale scores on the 1st, 3rd, 7th and 30th day after surgery in the subxiphoid surgery group were lower than those in the control group.ConclusionThe subxiphoid uni-portal thoracoscopic approach can achieve total thymectomy with less trauma and faster postoperative recovery.
ObjectiveTo explore the risk factors of myasthenic crisis after thymectomy (MCAT) for patients with myasthenia gravis (MG). MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 8, 2015), Web of Knowledge, CBM, CNKI and WanFang Data from inception to August 31, 2015, to collect case-control studies and retrospective cohort studies about the MCAT for patients with MG. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using Stata 13.0 software. ResultsA total of 17 studies involving 394 patients with myasthenic crisis and 1642 controls were included. Of the 17 studies, 11 were retrospective cohort studies and 6 were case-control studies. The results of meta-analysis showed that:a) univariate analysis indicated that history of myasthenic crisis (OR=8.05, 95%CI 5.80 to 11.15, P<0.01), bulbar symptoms (OR=5.10, 95%CI 3.01 to 8.67, P<0.01), preoperative severity of gravis (Osserman-stage) (OR=10.55, 95%CI 7.28 to 15.30, P<0.01), postoperative pulmonary infection (OR=10.77, 95%CI 3.88 to 29.95, P<0.01), thymoma (OR=2.37, 95%CI 1.50 to 3.75, P<0.01), dose of pyridostigmine (MD=0.45, 95%CI 0.29 to 0.62, P<0.01), AChRAb level >100 nmol/L (OR=12.14, 95%CI 4.80 to 30.73, P<0.01) and operation time (MD=0.57, 95%CI 0.26 to 0.88, P<0.01) were the risk factors of MCAT; b) multivariate analysis showed that, history of myasthenic crisis (OR=5.06, 95%CI 2.30 to 11.14, P<0.01), bulbar symptoms (OR=5.21, 95%CI 2.62 to 10.35, P<0.01), preoperative severity of gravis (Osserman-stage) (OR=5.82, 95%CI 2.60 to 13.04, P<0.01) and AChRAb level >100 nmol/L (OR=8.38, 95%CI 3.31 to 23.08, P<0.01) were the independent risk factors of MCAT. ConclusionThe independent risk factors of MCAT for patients with MG are history of myasthenic crisis, bulbar symptoms, preoperative severity of gravis (Osserman-stage) and AChRAb level >100 nmol/L.
Objective To explore the clinical efficacy and learning curve of robot-assisted thymectomy via subxiphoid approach. MethodsThe clinical data of patients with robot-assisted thymectomy surgery via subxiphoid approach performed by the same surgical team in the Department of Thoracic Surgery of Shanghai Pulmonary Hospital from February 2021 to August 2022 were retrospectively analyzed. The cumulative sum (CUSUM) analysis and best fit curve were used to analyze the learning curve of this surgery. The general information and perioperative indicators of patients at different learning stages were compared to explore the impact of different learning stages on clinical efficacy of patients. ResultsA total of 67 patients were enrolled, including 31 males and 36 females, aged 57.10 (54.60, 59.60) years. The operation time was 117.00 (87.00, 150.00) min. The best fitting equation of CUSUM learning curve was y=0.021 2x3–3.192 5x2 +120.17x–84.444 (x was the number of surgical cases), which had a high R2 value of 0.977 8, and the fitting curve reached the top at the 25th case. Based on this, the learning curve was divided into a learning period and a proficiency period. The operation time and intraoperative blood loss in the proficiency stage were significantly shorter or less than those in the learning stage (P＜0.001), and there was no statistical difference in thoracic drainage time and volume between the two stages (P＞0.05). ConclusionThe learning process of robot-assisted thymectomy via subxiphoid approach is safe, and this technique can be skillfully mastered after 25 cases.
Thymectomy is a major surgical procedure for patients with non-thymomatous myasthenia gravis，and can enhance their symptomatic remission rate and cure rate. There is still much controversy about appropriate surgical approach and extent of resection of thymectomy. The majority of thoracic surgeons believe that the completeness of thymectomy is closely associated with clinical symptom improvement，and perform complete resection of encapsulated thymus and surroun-ding fat tissues via mid-sternotomy. But minimally invasive thymectomies are often more acceptable by patients. On the contrary，in view of common existence of ectopic thymus tissue，some thoracic surgeons advocate a combination of cervical incision and sternotomy in order to further completely remove all thymus tissue.
Objective To observe the clinical manifestations and treatment of ocular myasthenia gravis. Methods The clinical manifestations, results of laboratory examination and thymic CT, and therapeutic data of 84 patients with ocular myasthenia gravis, hospitalized from July, 1998 to July, 2005, were retrospective ly analyzed. Results These patients were 2.5 to 70 years old. All of the patients had ptosis, includine 35.77% with diplopia 25% with strabismus; 1 with obnormal sphincter muscle and 1 with blurry vision.The positive rate of examination of AchR antibody was 27.6%, and abnormal rate of examination of thymic CT was 64.3%. The cure rate was 48.1% in oral administration with tabellae in whomdostigmini group, 66.7% in methylprednisolonum hormone therapy group, and 51.9%in thymectomy group. Conclusions Ocular myasthenia gravis is mostly involved levator palpebrae superiors and sometimes also involved other ocular muscles. Anticholinesterase medication, methylprednisolonum hormone therapy or thymec tomy are effective. (Chin J Ocul Fundus Dis, 2006,22:379-381)