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.
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)
ObjectiveTo analyze the surgical efficacy and influencing factors of myasthenia gravis (MG) patients with thymic atrophy after thymectomy. MethodsThe clinical data of MG patients with thymic atrophy undergoing thymectomy between October 2014 and May 2018 in Daping Hospital of Army Medical University and Shijiazhuang People Hospital were retrospectively analyzed. ResultsA total of 71 patients were collected, including 40 males and 31 females with a mean age of 45.17±12.42 years. All patients received the surgery successfully. After the surgery, 20 (28.17%) patients were stable remission, 12 (16.90%) patients were minimal manifestation status,19 (26.76%) patients were improved, 5 (7.04%) patients showed no change, 3 (4.23%) patients were worsened, 10 (14.08%) patients were exacerbated and 2 (2.82%) patients were dead. Multivariate logistic regression analysis showed that the preoperative illness duration (OR=4.61, 95%CI 1.13-18.85, P=0.03), and postoperative pyridostigmine combined with immunosuppressive (OR=0.12, 95%CI 0.03-0.45, P=0.00) were independent risk factors for long-term efficacy of thymectomy for MG patients with thymic atrophy. ConclusionEarly surgery after diagnosis of MG and postoperative pyridostigmine combined with immunosuppressive treatment is beneficial to the prognosis of MG patients with thymic atrophy.
ObjectiveTo evaluate the efficacy and safety of robot-assisted thymectomy (RATS) versus video-assisted thoracoscopic thymectomy (VATS). MethodsWeb of Science, PubMed, EMbase, The Cochrane Library, Wanfang, VIP and CNKI databases were searched by computer from inception to February 2022. Relevant literatures that compared the efficacy and safety of RATS with those of VATS were screened. The Newcastle-OttawaScale (NOS) was used to evaluate the quality of included cohort studies, and Review Manager 5.4 software was utilized to perform a meta-analysis. ResultsA total of 16 retrospective cohort studies were included, covering a total of 1 793 patients (874 patients in the RATS group and 919 patients in the VATS group). The NOS scores of the included studies were≥7 points. Meta-analysis results revealed that RATS had less intraoperative bleeding (MD=−22.45, 95%CI −34.16 to −10.73, P<0.001), less postoperative chest drainage (MD=−80.29, 95%CI −144.86 to −15.72, P=0.010), shorter postoperative drainage time (MD=−0.69, 95%CI −1.08 to −0.30, P<0.001), shorter postoperative hospital stay (MD=−1.14, 95%CI −1.55 to −0.72, P<0.001) and fewer conversion to thoractomy (OR=0.40, 95%CI 0.23 to 0.69, P=0.001) than VATS; whereas, the operative time (MD=8.37, 95%CI −1.21 to 17.96, P=0.090), incidence of postoperative myasthenia gravis (OR=0.85, 95%CI 0.52 to 1.40, P=0.530), overall postoperative complications rate (OR=0.80, 95%CI 0.42 to 1.50, P=0.480) and tumour size (MD=−0.18, 95%CI −0.38 to 0.03, P=0.090) were not statistically different between the two groups. ConclusionIn the aspects of intraoperative bleeding, postoperative chest drainage, postoperative drainage time, postoperative hospital stay and conversion to thoracotomy, RATS has unique advantages over the VATS.
ObjectiveTo investigate the effect of noninvasive ventilation (NIV) in patients with myasthenic crisis after thymectomy. Methods31 myasthenic crisis patients after thymectomy who initially used NIV,admitted in the First Affiliated Hospital of Guangzhou Medical University between January 2011 and June 2013,were analyzed retrospectively.They were assigned to two groups according to the successful application of NIV or not,with 13 patients in the NIV success group and 18 patients in the NIV failure group.The related factors including gender,age,APACHEⅡ score when admitted to ICU,the results of blood gas analysis before NIV,thymoma or not,the history of myasthenic crisis,the history of chronic lung disease,and minute ventilation accounted for the largest percentage of predicted value (MVV%pred)were analyzed. ResultsThere were no significant differences in age,gender,or APACHEⅡ score between two groups (P>0.05).The PaCO2 in the NIV success group was lower than that in the NIV failure group.The preoperative MVV%pred in the NIV success group was higher than that in the NIV failure group.There were no significant differences between two groups in pH,PO2,thymoma or not,the history of myasthenic crisis,or the history of chronic lung disease (P>0.05).If using the 45 mm Hg as the cut-off value of PaCO2 and 60% as the cut-off value of MVV%pred,the incidence of PaCO2<45 mm Hg and the incidence of MVV%pred>60% were higher in the NIV success group than those in the NIV failure group (84.6% vs.33.3%, P<0.05;100% vs. 55.6%,P<0.05).Logistic regression analysis revealed that PaCO2<45 mm Hg was an independent influence factor for successful application of NIV in patients with myasthenic crisis after thymectomy. ConclusionPaCO2<45 mm Hg can be a predictor of successful application of NIV in patients with myasthenic crisis after thymectomy.For the patients underwent NIV whose PaCO2<45 mm Hg or MVV%pred<60%,the clinician should predict the possibility of failure and prepared for intubation.