Eight-year follow-up of patients with myasthenia gravis after thymectomy
Eight-year follow-up of patients with myasthenia gravis after thymectomy
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DOI：
10.1111/ane.12289
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发表时间：
2015-02-01
影响因子：
3.5
通讯作者：
Bu, B.
中科院分区：
文献类型：
--
作者：
Yu, S.;Li, F.;Bu, B.
目的探讨胸腺切除联合免疫治疗重症肌无力患者的远期疗效及可能影响疗效的因素。方法回顾性分析1984年1月至2011年12月在同济医院行胸腺扩大切除术的306例重症肌无力患者的临床资料。在随访期间，针对每个病例进行药物治疗。胸腺瘤型重症肌无力围手术期死亡9例，随访297例，随访时间8.6年。至末次随访时，241例（81.1%）患者获得满意疗效，24例（8.1%）患者死亡，32例（10.8%）患者病情不变或恶化。术前有眼部重症肌无力、无胸腺瘤、无合并症是获得满意疗效的有利因素。值得一提的是，非胸腺瘤型重症肌无力患者的完全稳定缓解率和临床缓解率明显高于胸腺瘤型重症肌无力患者。非胸腺瘤型重症肌无力患者的预后比胸腺瘤型重症肌无力患者好得多。然而，必须采取适当的谨慎停止药物治疗，因为复发仍然是一个主要问题后，病人谁已经经历了胸腺切除术成为无复发。
PurposeTo depict the long-term outcome of patients with myasthenia gravis after thymectomy in combination with immunotherapy, and the factors that may potentially affect the outcome.MethodsThe 306 patients with myasthenia gravis who underwent extended thymectomy from January 1984 to December 2011 at Tongji Hospital were retrospectively evaluated.ResultsThe patients consisted of 174 cases with thymoma and 132 cases without thymoma. Pharmaceutical treatment was tailored for each case during follow-up. Nine patients with thymomatous myasthenia gravis died during the perioperative period, and 297 patients were followed for 8.6years. By their latest visits, 241 patients (81.1%) gained satisfactory efficacy, 24 cases died (8.1%), and 32 cases (10.8%) remained unchanged or deteriorated. Favorable factors for satisfactory efficacy included the presence of ocular myasthenia gravis before operation, no presence of thymoma, and lack of concomitant diseases. It is interesting to mention that, patients with non-thymomatous myasthenia gravis obtained significantly higher rates of complete stable remission and clinical remission than the patients with thymomatous myasthenia gravis.ConclusionsExtended thymectomy combined with immunotherapy is a preferred treatment with a satisfactory long-term remission rate. Patients with non-thymomatous myasthenia gravis have a much more promising prognosis than the patients with thymomatous myasthenia gravis. However, appropriate caution must be taken to discontinue pharmaceutical therapy as relapse remains a major concern after a patient who has already undergone thymectomy becomes symptom-free.