Objective To study clinical efficacy of video-assisted thoracic surgery (VATS) for myasthenia gravis(MG)and its effect on regulatory T cell (Treg) in peripheral blood. Methods Totally 100 cases of MG complicated with thymic hyperplasia or thymoma from June 2011 to June 2016 were enrolled, 42 cases received VATS were made as observation group and other 58 cases received small-incision sternotomy transverse second intercostal bones were made as control group. The operation completion rate, perioperative complications rate, operation indexes including mean operation time, intraoperative blood loss, postoperative drainage time, drainage volume and pain VAS scores at 1 d, 3 d and 7 d after operation were compared. Intracellular Foxp3 and CTLA-4 levels in CD4+, CD25 + and Treg in peripheral blood before and at 7d after operation were detected by flow cytometry. The clinical efficacy rate after at least one-year follow-up was also compared. Results The operation completion rates were both 100％ in the two groups, while complication rate in the observation group was significantly lower than that in the control group(P＜ 0.05). The mean operation time in the two groups had no statistical difference. While the blood loss, drainage time and drainage volume in the observation group were all significantly less (P＜0.05). The VAS scores after 1 d, 3 d and 7 d in the observation group were all significantly lower(P＜ 0.05). The levels of Foxp3 and CTLA-of CD4 +, C25 + and Treg in the observation group after 7 d was significantly higher(P＜0.05). The clinical efficacy rate in the observation group was better(P＜ 0.05). Conclusion VATS can bring high operation completion rate, less complication, minimal invasion, less pain, more Treg in peripheral blood and more clinical efficacy rate for MG, and it is safe and effective.%目的 研究电视胸腔镜手术(VATS)治疗重症肌无力(MG)的临床疗效及对外周血调节性T细胞(Regulatorycells,Treg)水平的影响.方法 MG伴胸腺增生或胸腺瘤病人100例,其中观察组42例,采用VATS治疗,对照组58例,采用经第2肋间胸骨横断小切口切除术;比较两组病人手术完成率和围术期并发症发生率,手术指标包括平均手术时间、术中出血量、术后引流时间和引流量,术后1天、3天和7天疼痛VAS评分,采用流式细胞术检测术前和术后7天外周血CD4 + CD25+Treg细胞内Foxp3和CTLA4水平;随访至少1年,比较两组病人临床有效率.结果 两组手术完成率100％,观察组和对照组并发症发生率分别为低于9.5％和25.7％,差异有统计学意义(P＜0.05).对照组和观察组手术时间分别为(124±26)分钟和(123±35)分钟,两组比较差异无统计学意义(P＞0.05).观察组术中出血量、术后引流时间和引流量分别为(78±22)ml、(35.6±5.3)小时和(256±57)ml,对照组分别为(123±35)ml、(48.9±5.4)小时、(323±62)ml,两组比较差异有统计学意义(P＜0.05)观察组术后1天、3天和7天疼痛VAS评分显著低于对照组,差异有统计学意义(P＜0.05).观察组术后7天外周血CD4+CD25 + Treg细胞内Foxp3和CTLA4水平明显高于对照组,差异有统计学意义(P＜0.05).随访观察组临床总有效率高于对照组,差异有统计学意义(P＜0.05).结论 VATS治疗MG成功率高,并发症少,具有微创性、疼痛轻,可增加外周血Treg细胞水平,临床有效率高,具有较好的安全性和有效性.
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