Thymectomy for myasthenia gravis: a 27-year experience
Thymectomy for myasthenia gravis: a 27-year experience
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DOI：
10.1016/s1010-7940(99)00052-4
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发表时间：
1999-05-01
影响因子：
3.4
通讯作者：
Ricci, C
中科院分区：
文献类型：
--
作者：
Venuta, F;Rendina, EA;Ricci, C
目的：胸腺切除术被认为是治疗重症肌无力(MG)的有效方法，我们回顾了27年来外科治疗重症肌无力的远期疗效和影响预后的因素。方法：1970~1997年间，我们对重症肌无力患者施行了232例胸腺切除术。15名患者失访；其余217名患者为我们的研究对象。胸腺瘤62例(28.4%)，肌无力按改良Osserman分级：I级51例(23%)，IIA级81例(37.3%)，IIB级52例(24%)，III级26例(12%)，IV级7例(3.2%)。58例胸腺瘤患者经胸骨正中切开行胸腺切除术，4例经翻盖切口行胸腺切除术。46例非胸腺瘤性MG患者采用标准颈椎切开术，101例采用部分胸骨上劈开切口，8例采用完全胸骨正中切开术。结果：手术死亡率0.92%(2例)。平均随访119个月后，71%的患者的临床状况有所改善(25%没有药物治疗或无症状；46%的患者减少用药和/或临床症状改善)；39(18%)患者病情稳定，没有临床变化；12(5%)患者的临床状态恶化，症状加重，需要更多药物，或两者兼而有之。因MG死亡13例(6%)，平均生存期34.3+/-3.6个月。胸腺瘤的存在对预后有负面影响。年龄较小的患者在手术前症状持续时间较短，预后较好；肌无力级别较低的患者有较高的缓解率。结论：胸腺切除术是治疗重症肌无力各期患者的有效方法，发病率低。胸腺瘤患者的预后较差。(C)1999由爱思唯尔科学公司出版。版权所有。
Objective: Thymectomy is considered an effective therapeutic option for patients with myasthenia gravis (MG), We reviewed our 27-year experience with surgical treatment of MC with respect to long-term results and factors affecting outcome. Methods: Between 1970 and 1997, we performed 232 thymectomies for MG. Fifteen patients were lost to follow-up; the remaining 217 form the object of our study. Sixty-two patients (28.4%) had thymoma, Myasthenia was graded according to a modified Osserman classification: 51 patients (23.%) were in class I, 81(37.3%) in class IIA, 52 (24%) in class IIB, 26 (12%) in class III and seven (3.2%) in class IV. Mean duration of symptoms before the operation was 12 +/- 10 months. Fifty-eight thymectomies for thymoma were performed through a median sternotomy and four through a clamshell incision. Forty-six thymectomies for non-thymomatous MG were performed through a standard cervicotomy, 101 procedures through a partial upper sternal-splitting incision and eight through a complete median sternotomy. Results: Operative mortality was 0.92% (two patients). After a mean follow-up of 119 months, 71% of all patients improved their clinical status (25% without medications and asymptomatic; 46% with a reduction of medications and/or clinically improved); 39 (18%) have a stable disease with no clinical modifications; 12 (5%) presented a deterioration of their clinical status with worse symptoms, required more medications, or both. Thirteen patients (6%) died because of MG (mean survival 34.3 +/- 3.6 months). The presence of a thymoma negatively influenced the prognosis. Younger patients showed a more favorable outcome as well as patients with a shorter duration of symptoms before the operation; patients with lower classes of myasthenia showed a higher rate of remission. Conclusions: Thymectomy is effective in the management of patients with MG at all stages with low morbidity. Patients with thymoma present a less favorable outcome. (C) 1999 Published by Elsevier Science B.V. All rights reserved.