目的:对照研究经剑突肋缘下入路与右侧肋间隙入路胸腔镜(VATS)胸腺扩大切除治疗非胸腺瘤重症肌无力(MG)的手术特点和疗效。方法:回顾性分析2015年8月至2019年8月我科实施的胸腔镜胸腺扩大切除手术治疗非胸腺瘤MG患者230例，根据手术入路和手术方式的不同，分为经剑突肋缘下入路(剑突肋缘下组102例)和经右侧肋间隙入路(右侧肋间隙组128例)。结果:剑突肋缘下组患者术中出血量[(30.3±25.2)ml和(45.1±30.6)ml，n t＝－3.935，n P＝0.003]和术后引流量[(178.6±90.5)ml和(205.4±87.6)ml，n t＝－2.27，n P＝0.024]较右侧肋间隙组明显减少；术后疼痛更轻[NRS评分：(3.1±1.0)分和(4.6±1.5)分，n t＝－8.677，n P＝0.001]。观察孔愈合不良率剑突肋缘下组低于右侧肋间隙组，但无统计学差异(1/102和7/128，n χ2＝2.200，n P＝0.138)。完全缓解率(29.6%和32.4%，n χ2＝0.196，n P＝0.658)和术后总有效率(85.7%和84.7%，n χ2＝0.044，n P＝0.834)，剑突肋缘下组和右肋间隙组差异无统计学意义。n 结论:经剑突肋缘下入路胸腔镜胸腺扩大切除手术治疗MG的安全性和有效性高。该术式具有创伤更小，术后并发症发生率更低的优点，更加适合不能双腔插管、不耐受单肺通气和肺功能不全的老年、女性MG患者。“,”Objective:To compare the characteristics and therapeutic effects of video-assisted thoracoscopic(VATS)extended thymectomy by subxiphoid-costal margin approach versus right intercostal approach for the treatment of myasthenia gravis(MG).Methods:A retrospective analysis was conducted on 230 non-thymomatous MG patients undergone VATS extended thymectomy in our department from August 2015 to August 2019.According to the operation approach and method, patients were divided into two groups: the subxiphod-costal margin approach group(n=102)and the right intercostal approach group(n=128).Results:Intraoperative blood loss and the postoperative drainage were less in the subxiphod-costal margin approach group than in the right intercostal approach group[(30.3±25.2) ml n vs. (45.1±30.6) ml, (178.6±90.5) ml n vs.(205.4±87.6) ml, n t=-3.935 and -2.27, n P=0.003 and 0.024)]. Postoperative pain degree was lower in the subxiphod-costal margin approach group than in the right intercostal approach group [the Numerical Rating Scale(NSR)scores: 3.1±1.0 n vs. 4.6±1.5, n t=-8.677, n P=0.001]. A difference in incidence rate of pore malunion also existed between the subxiphod-costal margin approach group and the right intercostal approach group, but it had no statistical significance(1/102 n vs. 7/128, n χ2=2.200, n P=0.138). The complete remission rate and the overall effectiveness rate had no significant difference between the two groups(29.6% n vs.32.4%, 85.7% n vs. 84.7%, n χ2=0.196 and 0.044, n P=0.658 and 0.834).n Conclusions:VATS extended thymectomy by subxiphoid-costal margin approach shows excellent safety and effectiveness in treating MG.It has advantages of low trauma and complications, and is particularly suited for elderly and female MG patients who are unable to receive double-lumen endotracheal intubation, are intolerant to one-lung ventilation or have pulmonary insufficiency.