Open versus thoracoscopic thymectomy for juvenile myasthenia gravis
Open versus thoracoscopic thymectomy for juvenile myasthenia gravis
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DOI：
10.1016/j.jpedsurg.2019.11.013
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发表时间：
2020-09-01
影响因子：
2.4
通讯作者：
Partrick, David A.
中科院分区：
文献类型：
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作者：
Derderian, S. Christopher;Potter, D. Dean;Partrick, David A.
背景：幼年型重症肌无力(JMG)是一种抗体介导的自身免疫性疾病，表现为进行性的肌肉无力和疲劳。在医学难治性病例中，胸腺切除术已被证明可以消除症状并减少对糖皮质激素的依赖。虽然经宫颈或经胸骨切开一直是传统的方法，但成人现在倾向于胸腔镜胸腺切除术。在儿童中几乎没有数据支持这种方法。方法：对2001年至2018年在两家儿科机构接受JMG胸腺切除术的所有20岁以下的患者进行了回顾。将儿童分为开腹(经宫颈或经胸骨)组和胸腔镜组，比较两组的基线特征、围手术期和术后结果。结果：在18年的研究期间，共进行了34例胸腺切除术，其中18例经开腹手术，16例经胸腔镜术。开胸手术时间明显短于胸腔镜组(分别为108±49和145±43分钟，P=0.025)。胸腺镜下胸腺切除术与术中出血量(5.5+/-6.0vs55+/-67ml，p=0.007)、术后静脉麻醉用药时间(5.0+/-1.5vs20+/-23h，p=0.018)和住院时间(1.7+/-1.0vs2.7+/-1.1clays，p=0.009)相关。两组均未发生围手术期并发症。两组患儿均有94%的临床改善。结论：胸腔镜术是治疗JMG的一种安全有效的手术方法。儿童、家庭和转诊神经科医生对这种微创方法的接受度增加，可能使早期手术干预成为可能。研究类型：临床研究论文。(C)2019年由Elsevier Inc.出版。
Background: Juvenile myasthenia gravis (JMG) is an antibody mediated autoimmune disorder that manifests as progressive voluntary muscle weakness and fatigue. In medically refractory cases, thymectomy has been shown to abrogate symptoms and reduce glucocorticoid dependence. While transcervical or transsternal incisions have been the traditional approach, adult trends now favor thoracoscopic thymectomy. Little data exist to support this approach in children.Methods: A retrospective review of all patients younger than 20 years of age who underwent a thymectomy for JMG at two pediatric institutions between 2001 and 2018 was performed. Children were divided into either an open (transcervical or transsternal) or thoracoscopic group and baseline characteristics, perioperative, and postoperative outcomes were compared.Results: Thirty-four thymectomies were performed during the 18-year study period; 18 via an open and 16 via a thoracoscopic approach. The operative time was shorter for open procedures compared thoracoscopic ones (108 +/- 49 and 145 +/- 43 min, respectively, p = 0.025). Thoracoscopic thymectomy was associated with less intraope rative blood loss (5.5 +/- 6.0 vs 55 +/- 67 ml, p = 0.007), decreased duration of postoperative intravenous narcotic use (5.0 +/- 1.5 vs 20 +/- 23 h, p = 0.018), and a shorter length of hospitalization (1.7 +/- 1.0 vs 2.7 +/- 1.1 clays, p = 0.009). No perioperative complication occurred in either group. Clinical improvement was reported in 94% of children in both groups.Conclusions: Thoracoscopic thymectomy in children is a safe and effective surgical technique for the treatment of JMG. Increased acceptance of this minimally invasive approach by children, families, and referring neurologists may enable earlier surgical intervention.Type of study: Clinical research paper. (C) 2019 Published by Elsevier Inc.