[Perioperative management and video-assisted thoracoscopic extended thymectomy for myasthenia gravis].

OBJECTIVE

To investigate the perioperative management and video-assisted thoracoscopic (VATS) extended thymectomy for myasthenia gravis (MG).

METHODS

A total of 102 patients who received extended thymectomy for MG from June 2000 to August 2007 were divided into 2 groups by operative approach: 51 in the VATS group and 51 in the full median sternotomy group. The clinical features, including operation time, operation blood loss, post-operative drainage, incidence of crisis, hospital stay, and the 1-year total effective rate after the operation were compared. Complications were treated exactly and cholinesterase inhibitors were applied to control the symptom of MG before the operation. The whole thoracic gland and fat in the anterior mediastinum were removed. Steroid, cholinesterase inhibitors and plasmapheresis were used to prevent and cure myasthenic crisis after the operation.

RESULTS

No patients died in the operation and hospitalization. There was no significant difference in the operation time [(128.14+/-34.82) min vs. (130.46+/-28.71) min] and the 1-year total effective rate after the operation (85.8% vs. 87.2%)in the 2 groups (P>0.05). The operation blood loss, postoperative drainage, incidence of crisis, and postoperative hospital stay in the median sternotomy group were higher or longer than those in the VATS group [(93.77+/-21.64) mL vs. (45.42+/-10.96) mL,P<0.05; (174.65+/-21.64) mL vs. (101.33+/-28.76) mL, P<0.01;7.84% vs. 1.96%, P<0.05; (14.23+/-3.17) d vs. (8.37+/-1.18) d, P<0.05)].

CONCLUSION

VATS extended thymectomy for myasthenia gravis is safe, less invasive and effective. Preoperative preparation and the perioperative management can decrease the incidence of crisis. The plasmapheresis is the key of curing myasthenic crisis.