Factors influencing the outcome of transsternal thymectomy for myasthenia gravis
Factors influencing the outcome of transsternal thymectomy for myasthenia gravis
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DOI：
10.1111/j.1600-0404.2005.00424.x
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发表时间：
2005-08-01
影响因子：
3.5
通讯作者：
Huang, MH
中科院分区：
文献类型：
--
作者：
Huang, CS;Hsu, HS;Huang, MH
背景-胸腺切除术是目前重症肌无力（MG）患者的治疗策略之一；然而，手术的选择标准仍然存在争议。方法：回顾性分析1986年6月至2000年12月行胸腺经胸骨切除术的168例MG患者的人口学资料和手术结果。通过查阅医院记录或电话联系获得后续信息。术后每隔1、3、6个月评估MG的情况，然后每年评估一次。比较两组患者的完全缓解率（CRR）。结果-共分析168例患者，其中男性69例，女性99例，平均年龄38.3岁（13-80岁）。术前症状持续时间1 ~ 312个月，平均33.8个月。154例（91.6%）患者获得完整的随访信息，平均随访时间为98.9个月。154例患者中有89例（57.8%）完全缓解，47例（30.5%）显著临床改善。总改良率为88.3%。24例眼部MG患者中有17例（70.8%），35例胸腺瘤患者中有18例（51.4%）在随访期间达到完全缓解。CRR逐年升高，术后第4年达到平稳期。无手术死亡率。并发症发生率为16.6%。单因素分析显示，年龄< 35岁（P = 0.0001）、术前症状持续时间< 24个月（P = 0.01）、术前未接受类固醇治疗（P = 0.04）是预后的有利因素。多因素Cox回归分析显示，年龄< 35岁（优势比为3.645,P = 0.001）、术前症状持续时间< 24个月（2.311,P = 0.041）是经胸骨胸腺切除术患者预后的有利因素。结论：经胸骨胸腺切除术治疗各阶段MG患者均可行，治愈率高，手术发病率低。手术年龄小于或等于35岁，且术前症状出现时间小于24个月的患者，可能从胸腺切除术中获益更多。有胸腺瘤的MG患者和没有胸腺瘤的患者一样好，35名胸腺瘤患者中有18名在随访期间完全缓解。胸腺切除术似乎对眼部MG也有益。
Background - Thymectomy is one of the current treatment strategies for patients with myasthenia gravis (MG); however, the selection criteria for surgery remain controversial. Methods - The demographic data and the surgical results of 168 patients with MG who underwent transsternal thymectomy from June 1986 to December 2000 were retrospectively reviewed. Follow-up information was obtained by review of the hospital records or telephone contact. The postoperative status of MG was assessed at the interval of 1, 3 and 6 months and then annually. The complete remission rate (CRR) between groups was compared. Results - A total of 168 patients, including 69 male patients and 99 female patients, with a mean age of 38.3 years (range 13-80 years), were analyzed. The symptom duration before operations was from 1 to 312 months with a mean of 33.8 months. Complete follow-up information was obtained on 154 patients (91.6%) with a mean follow-up duration of 98.9 months. Complete remission was achieved in 89 of 154 patients (57.8%) and marked clinical improvement in 47 patients (30.5%). Total improvement rate was 88.3%. Seventeen of 24 patients (70.8%) with ocular MG and 18 of 35 patients (51.4%) with thymoma had reached complete remission during the follow-up period. The CRR increased with each consecutive year and reached the plateau in the fourth postoperative year. There was no surgical mortality. The complication rate was 16.6%. Univariate analysis demonstrated that age < 35 years old (P = 0.0001), symptom duration before operation < 24 months (P = 0.01) and absence of preoperative steroid treatment (P = 0.04) were favorable prognostic factors. Multivariate Cox regression analysis revealed age < 35 years old (odds ratio = 3.645, P = 0.001), symptom duration before operation < 24 months (2.311, P = 0.041) were favorable prognostic factors for patients having transsternal thymectomy. Conclusions - Transsternal thymectomy is feasible in the management of patients with MG at all stages with high improvement rate and low surgical morbidity. Those patients aged 35 years or less at operation, with symptoms developed < 24 months before operation, may benefit more from thymectomy. MG patients with thymoma did as well as patients without thymoma, and 18 of 35 patients with thymoma had reached complete remission during the follow-up period. Thymectomy seems to be beneficial also for ocular MG.