［Abstract］　Objective　To explore the application value of Da Vinci robot to perform the extended thymectomy for the treatment of myasthenia gravis through the three-port subxiphoid approach. Methods　From June 2021 to March 2023, 23 patients with myasthenia gravis who received Da Vinci Xi robot to perform the extended thymectomy for the treatment of myasthenia gravis through the three-port subxiphoid approach in the Department of Thoracic Surgery of Jiangxi Provincial People′s Hospital were included in this study. The indicators such as surgical time, intraoperative blood loss, postoperative hospitalization time, and the Quantitative Myasthenia Gravis Scale(QMGS) score 2 months after surgery were statistically analyzed. Results　The operations of all the patients were successfully completed, and there was no conversion to thoracotomy and no perioperative death. The surgical time was 130-370(228.46±81.02)minutes. The intraoperative bleeding volume was 20-250(92.30±87.86)ml. The time of admission to the thoracic intensive care unit(ICU) after surgery was 1-18(3.54±4.58)days. The postoperative tracheal intubation ventilator assisted ventilation time was 1-8(1.77±2.17)days. The postoperative 24-hour thoracic drainage was 70-380(179.62±101.31)ml. The postoperative thoracic tube cannulation time was 2-12(4.62±2.90)days. The postoperative hospitalization time was 4-32(10.38±7.88)days. The volume of resected tumor specimens was 126.0-538.2(275.22±140.29)cm³ and the number of dissected lymph nodes was 1-26(5.62±7.72). All the dissected lymph nodes were oncology-negative. The QMGS scores were (4.46±4.31)points 2 months after surgery, and the relative scores of QMGS were (0.59±0.24)points 2 months after surgery. No significant abnormalities were found on the chest computed tomography(CT) 2 months after surgery. No other complications occurred except for one case of postoperative myasthenic crisis. Conclusion　The traditional thoracoscopic three-port subxiphoid approach has been modified and applied to Da Vinci robot for extended thymectomy, which can achieve complete thymectomy and clearance of mediastinal adipose tissues, making the operation safe and reliable, and the therapeutic effects of myasthenia gravis are definite.]]> 2023/7/3 10:09:37 XI Jin-feng, XU Quan 5true ［Abstract］　The treatments of myasthenia gravis mainly include medication, surgical treatments and immunomodulatory therapy. The surgical treatments are increasingly becoming a main option for more patients with myasthenia gravis,among which, thoracoscopic extended thymectomy has become one of the main surgical procedures in myasthenia gravis. However, thoracoscopic extended thymectomy with double retractors subxiphoid has the advantages of better exposure of the retrosternal space, helping to completely resect the thymus and anterior mediastinal adipose tissues, having small surgical trauma and short hospital stay. This paper describes the basic operating process of the thoracoscopic extended thymectomy with double retractors subxiphoid.]]> 2023/7/3 10:09:37 ZHANG Cheng-cheng, WU Liang, FAN Jiang 4true ［Abstract］　Objective　To analyse the influencing factors of postoperative myasthenic crisis(POMC) in generalized myasthenia gravis(MG) patients. Methods　The clinical data of 116 patients with generalized MG who underwent thymectomy in the Department of Thoracic Surgery of Xuanwu Hospital, Capital Medical University from January 2018 to June 2022 were retrospectively analyzed. The patients were divided into POMC group(38 cases) and non-POMC group(78 cases) according to whether they had developed POMC. Univariate and multivariate regression analyses were performed to determine the influencing factors of POMC. Results　The mechanical ventilation duration and intensive care unit(ICU) stay in the POMC group were significantly longer than those in the non-POMC group(P<0.001). There were statistically significant differences between the POMC group and non-POMC group in modified Osserman classification, whether thymoma was complicated with, operation method, forced vital capacity(FVC), forced expiratory volume in the first second(FEV₁) and albumin to globulin ratio(AGR)(P<0.05). The results of multivariate logistic regression analysis showed that Osserman classification, FVC, FEV₁ and AGR were the influencing factors for occurrence of POMC(P<0.05). Conclusion　Preoperative Osserman classification, FVC, FEV₁ and AGR are the influencing factors for the occurrence of POMC in the generalized MG patients, which can provide reference for clinical practice.]]> 2023/7/3 10:09:37 LI Yuan-bo, ZHANG Yi, SU Lei, et al. 3true ［Abstract］　Objective　To systematically evaluate the clinical efficacy, incidence of adverse reactions and patient satisfaction of high-quality nursing services in thymoma patients with myasthenia gravis. Methods　Randomized controlled clinical trials(RCTs) published before April 2023 were retrieved by computer from domestic and foreign databases. The domestic databases included Wanfang, China National Knowledge Internet(CNKI) and VIP, and the foreign databases included PubMed, science citation index(SCI), and the Cochrane Library, and Cochrane bias evaluation tool was used to evaluate the quality of the literature meeting the inclusion criteria, and the data related to the study characteristics and efficacy evaluation were extracted, and Revman software was used for meta-analysis. Results　A total of 15 RCTs with a total of 1 105 cases were included. The length of hospital stay outcomes was reported in 7 studies with 538 cases, and its effect value MD(95%CI) was -3.55(-4.96, -2.15). The effect value MD(95%CI) was 0.17(0.11, 0.26) in 14 studies with 1 005 cases whose incidence of adverse events were reported. In 7 studies, 519 cases with nursing satisfaction were reported, and its effect value MD(95%CI) was 7.59(3.95, 14.56). In 13 studies, 916 cases with the incidence of myasthenia gravis crisis were reported and its effect value MD(95%CI) was 0.25(0.13, 0.49). In 13 studies, 916 cases with the incidence of pulmonary infection were reported, and its effect value MD(95%CI) was 0.17(0.10, 0.30). Conclusion　High-quality nursing services in the thymoma patients with myasthenia gravis has better clinical efficacy, low incidence of adverse reactions, and higher patient satisfaction.]]> 2023/7/3 10:09:37 QIANG Ying, LIU Xue-qi, LIU Bao-dong, et al. 2true ［Abstract］　Thymoma is a tumor originating from thymic epithelial cells, with an incidence rate of about 0.2/100 000. Myasthenia gravis is a common symptom that accompanies thymoma, and it can cause myasthenic crisis and death in thymoma patients with myasthenia gravis. Thymectomy has become a common treatment method for thymoma with myasthenia gravis. This paper reviews the surgical treatment and research progress of thymoma with myasthenia gravis from the aspects of preoperative examination, clinical diagnosis and staging, surgical methods and approach selection, and prognosis.]]> 2023/7/3 10:09:37 XU Xin-yao, ZHAO Qi-rui, GUAN Liang, et al. 1true