0159

UPPER MINI-STERNOTOMY FOR EXTENDED THYMECTOMY IN MYASTHENIC GRAVIS IN CHILDREN

Li JH, Zhang ZW, Zhu XK, Hu J

Children's Hospital Affiliated Medical College of Zhejiang University, Hangzhou, China

Objective: To look for a minimal invasive approaches and better cosmetic result for extensive thymus glad remove in children with myasthenia gravis.

Method: Five 4 to 8 years old kids with myasthenia gravis were involved in this study last year. The patient is placed in supine position. A skin incision is made in midline just below the jugular notch within 3-4 cm. The sternum is splitted from up down to third intercostal space with Sarns saw. An appropriated small chest retractor is placed. The main portion of thymus glad lying just below the incision is well exposed. Thymus glad and the surrounding tissues are carefully removed. If there is thymus pole posterior to the innominate vein it is also easy to remove under direct vision. Then the sternum was closed with maxon stitch. Neither drain catheter nor flap were needed.

Result: All areolar tissue, fat and thymus glad were removed without any difficulty. Symptom of myasthenia gravis disappeared in 4 and progressed in 1.

Conclusion: Upper mini-sternotomy is a minimal invasive technique that allows an extended thymectomy while leaving the chest wall largely intact. This technique has the same surgical result as original one for children with myasthenia gravis. This technique has better results in pain control, improve respiratory function, less hospital stay and cosmetic outcome.