Extended thymectomy for myasthenia gravis patients: A 20-year review
Extended thymectomy for myasthenia gravis patients: A 20-year review
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DOI：
10.1016/s0003-4975(96)00376-1
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发表时间：
1996-09-01
影响因子：
4.6
通讯作者：
Monden, Y
中科院分区：
文献类型：
--
作者：
Masaoka, A;Yamakawa, Y;Monden, Y
背景资料。自1973年以来，由于胸腺组织在前纵隔脂肪组织中的存在，我们对重症肌无力进行了扩大的胸腺切除术。对随访结果进行回顾，并对影响因素进行分析。对375例重症肌无力患者(非胸腺瘤型286例，胸腺瘤型89例)行扩大胸腺切除术的临床资料进行了分析。病情评估：A(缓解)、B(好转)、C(无变化)、D(恶化)、E(重症肌无力死亡)。分别于术后3个月、6个月、1年、3年、5年、10年、15年、20年进行评估。通过每个时间点的缓解率(RR=A/评估的总人数)和缓解率(PR=A+B/评估的总人数)来评估手术效果。非胸腺瘤患者缓解率分别为15.2%(3个月)、15.9%(6个月)、22.4%(1年)、36.9%(3年)、45.8%(5年)、55.7%(10年)、67.2%(15年)和50.0%(20年)。胸腺瘤患者缓解率分别为13.6%(3个月)、17.5%(6个月)、27.5%(1年)、32.4%(3年)、23.0%(5年)、30.0%(10年)、31.8%(15年)和37.5%(20年)。无胸腺瘤、年龄较小和病程较短是有利的预后因素。胸腺切除术对眼肌无力重症患者也是有效的。术前应用类固醇治疗并不能改善预后。对于非胸腺瘤和胸腺瘤患者，扩大胸腺切除术是治疗重症肌无力的一种很好的手术方法。
Background. Since 1973 we have performed extended thymectomy for myasthenia gravis because of the presence of thymic tissue in the anterior mediastinal fatty tissue. Follow-up results were reviewed and influencing factors were investigated.Methods. Three hundred seventy-five patients with myasthenia gravis (286 nonthymomatous and 89 thymomatous) who have undergone extended thymectomies were reviewed. The status of the patients was evaluated as follows: A (remission), B (improvement), C (no change), D (deterioration), E (death due to myasthenia gravis). Evaluation was performed at 3 and 6 months, and at 1, 3, 5, 10, 15, and 20 years. The effectiveness of the operation was estimated by the remission rate (RR = A/Total number of patients evaluated) and the palliation rate (PR = A + B/Total number of patients evaluated) at each point.Results. Remission rates of the nonthymomatous patients were 15.2% (3 months), 15.9% (6 months), 22.4% (1 year), 36.9% (3 years), 45.8% (5 years), 55.7% (10 years), 67.2% (15 years), and 50.0% (20 years). Remission rates in the thymomatous patients were 13.6% (3 months), 17.5% (6 months), 27.5% (1 year), 32.4% (3 years), 23.0% (5 years), 30.0% (10 years), 31.8% (15 years), and 37.5% (20 years). Absence of thymoma, younger age, and short duration of the disease were favorable prognostic factors. Thymectomy was effective also in patients with ocular myasthenia gravis. Preoperative steroid administration did not improve the outcome.Conclusions. Extended thymectomy is an excellent operative procedure for myasthenia gravis in both nonthymomatous and thymomatous patients.