Extended cervicomediastinal thymectomy in the integrated management of myasthenia gravis
Extended cervicomediastinal thymectomy in the integrated management of myasthenia gravis
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DOI：
10.1097/00000658-199709000-00012
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发表时间：
1997-09-01
影响因子：
9
通讯作者：
Drachman, DB
中科院分区：
文献类型：
--
作者：
Bulkley, GB;Bass, KN;Drachman, DB
作者在一个单一机构的一个大系列的患者中评价了作为重症肌无力患者综合治疗组成部分的扩大颈纵隔胸腺切除术的反应。作者评价了治疗的反应相对于一个分级的，多变量的，有序的规模选择，以反映疾病的mappensation.Summary背景DataA系列，大小不等，描述了反应的重症肌无力患者胸腺切除术主要是相对于双变量终点的存在或不存在的“缓解”。"这些研究未能描述术后疾病严重程度的全谱，并且无法明确量化假定预后变量的影响，也无法明确评估随时间推移明显改善的统计学意义。MethodsThe作者评价了202例连续患者，他们从1969年到1996年在约翰霍普金斯医院接受经胸骨胸腺切除术治疗症状性重症肌无力。通过反映疾病全谱的标准化量表评估手术结合术后药物治疗的反应。这些数据进行了分析，通过一种新的平均多变量回归分析，允许量化的统计意义上的明显反应超过石灰和独立的影响，每个9个假定的预后indicators.ResultsThere是没有围手术期死亡率和围手术期发病率为33%的评价。在术后6个月至1年出现明显的临床反应，并持续至少10年。改善的中位增量为两个（五个）类。分别有86%和83%的患者在5年和10年时至少改善了一个等级。这些变化具有统计学显著性（p < 0.001）。然而，与传统的经胸骨胸腺切除术相比，使用扩大颈纵隔胸腺切除术与两倍以上的改善机会相关，（胸腺瘤的存在）也不是手术年龄被证明是术后responsibility.ConclusionsExtended颈纵隔胸腺切除术是重症肌无力综合治疗的一个组成部分，在整个组以及胸腺瘤患者亚组和40岁以上患者中观察到显著改善。
ObjectiveThe authors evaluated the response to extended cervicomediastinal thymectomy as a component of the integrated management of patients with myasthenia gravis in a large series of patients from a single institution. The authors evaluated the response to therapy with respect to a graded, multivariate, ordinal scale chosen to reflect the full range of the disease's manifestations.Summary Background DataA number of series, of varying sizes, describe the response of patients with myasthenia gravis to thymectomy primarily with respect to the bivariate endpoint of the presence or absence of ''remission.'' These studies fail to describe the full spectrum of postoperative disease severity and have been unable to quantify definitively the influence of putative prognostic variables, nor to assess definitively the statistical significance of apparent improvements over time.MethodsThe authors evaluated 202 consecutive patients who underwent trans-sternal thymectomy for symptomatic myasthenia gravis from 1969 through 1996 at the Johns Hopkins Hospital. The response to surgery, combined with postoperative medical therapy, was evaluated by a standardized scale reflecting the full spectrum of the disease. These data were analyzed by a novel mean multivariate regression analysis, which allowed the quantification of the statistical significance of apparent responses over lime and the evaluation of the independent influence of each of nine putative prognostic indicators.ResultsThere was no perioperative mortality and a 33% perioperative morbidity. There was a marked clinical response at 6 months to 1 year after surgery that was sustained for at least 10 years thereafter. The median increment of improvement was two (of five) classes. Eighty-six percent and 83% of the patients had improved by at least one class at 5 and 10 years, respectively. These changes were statistically significant (p < 0.001). Whereas the use of extended cervicomediastinal thymectomy was associated with a greater than twofold chance of improvement, compared to conventional trans-sternal thymectomy, neither the pathologic diagnosis (presence of thymoma) nor the age at surgery proved to be negative predictors of postoperative response.ConclusionsExtended cervicomediastinal thymectomy is the procedure of choice as a component of the integrated management of myasthenia gravis, with significant improvement seen in the group as a whole, as well as in subgroups of patients with thymoma and those older than 40 years of age.