Effect Of Video-assisted Thoracoscopic Expanding Thymectomy On Quality Of Life Of Patients With Myasthenia Gravis And Thymoma

Objective Myasthenia gravis is caused by acetylcholine receptor sensitization nerve-muscle joint dysfunction of autoimmune diseases,in part or whole body skeletal muscle weakness for clinical manifestations.It is reported that about 30% of the patients with thymoma associated with myasthenia gravis,and through the removal of the thymus and cleaning the before mediastinum fat can make 70% ~ 90% of patients with myasthenia gravis symptoms eased.Therefore,the first choice for treatment of myasthenia gravis with thymoma is expanding thymectomy.Video-assisted thoracoscopic surgery,as widely used in clinical in recent years because of the advantages of minimally invasive and quick recovery,is controversy in the treatment of myasthenia gravis with thymoma.In this retrospective study,the effect of video-assisted thoracoscopic expanding thymctomy on the treatment of thymoma and myasthenia gravis was discussed.Method The 95 patients with myasthenia gravis and thymoma,which was obtained from October 2009 to June 2016 in thoracic surgery department,were selected as the subjects of the study.All patients were divided into two groups according to the operative type.In the VATS group,47 patients underwent video-assisted thoracoscopic expanding thymctomy,others in the open surgery group were resect by the expanding thymctomy through sternum.Their thymus and the anterior mediastinal adipose tissue in two groups removed.The incidence of intraoperative blood volume,operative incision length,operative time,postoperative chest drainage time,intensive care time,postoperative hospital stay and perioperative complications were compared between the two groups.1 year after operation,according to the quality of life questionnaire (EORTC-QLQ)from European organization for research,the score of physical function,emotional function,social function,role function,cognitive function and the total quality of life were followed up.Results Compared with open surgery group,the VATS group’s intraoperative blood volume,surgical incision length,postoperative chest drainage duration,postoperative hospital stay and intensive care were less(P<0.05).However,there was no difference about surgical time between open surgery and VATS group(P>0.05).In the open surgery group,5 patients suffered from myasthenia,and the ratio was 9.09%.However,no myasthenia occurred in VATS group.Overall,the complications rate in VATS group was lower than it in open surgery group(P<0.05).Moreover,at 1day before surgery and1 year after surgery,there was no difference on EORTC-QLQ quality score of physical function,role function,cognitive function,emotional function,social function and the general quality of life score between the VATS group and open surgery group(P>0.05).However,the scores of EORTC-QLQ quality score of the two groups at the 1 year after surgery were higher than it at 1 year after surgery(P<0.05).Conclusion To sum up,compared with the sternum thymus expanded resection,thymus expanded resection under thoracoscope has a small wound,less blood loss,fast postoperative recovery,low incidence of perioperative complications and improved quality of life,which could be applied to the treatment of myasthenia gravis with thymoma.