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目的探讨胸腔镜胸腺扩大切除术的手术方法和适应证。方法利用胸腔镜进行胸腺扩大切除术共２２例。病种包括重症肌无力 １７例，其中Ⅰ型 ２例，Ⅱａ型 ４例，Ⅱｂ型 ６例，Ⅳ型 ５例，伴胸腺瘤 ９例；单纯胸腺瘤 ５例。切除范围从全胸腺组织到前纵隔和上纵隔的所有脂肪样软组织。瘤体在 ｃｍ以下胸腺瘤胸腺扩大切除术可以在内镜下完成。结果手术时间１～３ｈ，平均１．５ｈ，术中出血量＜１００ｍｌ，术后住院时间３～１５ｄ，平均６．５ｄ。重症肌无力组有效率８８％。单纯胸腺瘤组未见肿瘤复发。结论胸腔镜用于瘤体在 ２ ｃｍ以下胸腺瘤胸腺扩大切除术，手术方法可行、可靠，较好地保持了胸廓完整性和减少术后切口疼痛。对瘤体在４ ｃｍ以上胸腺瘤，胸腺扩大切除术最好结合微创伤小切口进行。
Objective To investigate the surgical methods and indications of thoracoscopic thymectomy. Methods Twenty-two patients underwent thoracoscopic thymectomy. Diseases included 17 cases of myasthenia gravis, including 2 cases of type I, 4 cases of type IIa, 6 cases of type IIb, 5 cases of type IV, 9 cases of thymoma, and 5 cases of simple thymoma. Resection ranged from total thymic tissue to all adipose-like soft tissues of the anterior mediastinum and superior mediastinum. The thymus enlargement of the thymoma can be performed under the endoscope. Results The operation time was 1 to 3 hours and the average time was 1.5 hours. The intraoperative blood loss was less than 100 ml. The postoperative hospital stay was 3 to 15 days with an average of 6.5 days. Myasthenia gravis group efficiency of 88%. No tumor recurrence was found in the simple thymoma group. [Conclusion] Thoracoscopic thoracoscopy is used to expand the thymus in tumors less than 2 cm in diameter. The surgical method is feasible and reliable. It can maintain the thoracic integrity and reduce postoperative incision pain. For thymoma tumors more than 4 cm in size, it is best to perform an enlarged thymectomy combined with a minimally invasive incision.