Prognostic factors for myasthenia gravis treated by thymectomy: Review of 61 cases
Prognostic factors for myasthenia gravis treated by thymectomy: Review of 61 cases
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DOI：
10.1016/s0003-4975(99)00310-0
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发表时间：
1999-06-01
影响因子：
4.6
通讯作者：
Sancho, LG
中科院分区：
文献类型：
--
作者：
Nieto, IP;Robledo, JPP;Sancho, LG
背景资料。重症肌无力(MG)的内科治疗包括使用抗胆碱酯酶药物、免疫抑制药物、血浆置换和丙种球蛋白。然而，这些药物的临床完全缓解率低至15%。因此，胸腺切除，最好是经胸骨入路，已被越来越多地接受为治疗MG的有效方法，据报道，完全临床缓解率高达80%。本文收集了西班牙马德里拉帕特大学医院1977年1月至1994年12月收治的61例重症肌无力患者的临床资料。所有患者均行胸腺切除术。本研究的目的是确定预测MG术后预后的主要预后因素。我们的结果表明，从发病到手术时间短于8个月的患者预后最好。奥斯曼I期和III期也与较高的临床完全缓解率相关。相比之下，年龄和性别与胸腺切除术后MG的预后均无明显关系，尽管女性患者的预后好于男性，而且患者越年轻，临床完全缓解的可能性越大。术后病理检查也未发现有预后价值。我们认为胸腺切除术对MG患者是一种有益的手术，术后5年的临床完全缓解率为46%。因此，我们主张MG患者在病程中尽早切除胸腺，因为从诊断到手术的时间是决定预后的主要因素。(C)1999年，由胸外科医生学会颁发。
Background. Medical treatment for myasthenia gravis (MG) involves the use of anticholinesterase agents, immunosuppressive drugs, plasmapheresis, and gamma-globulin. However, these agents result in a complete clinical remission rate as low as 15%. As a consequence, thymectomy, preferably by transsternal approach, has become increasingly accepted as an efficacious procedure for MG, with reported complete clinical remission rates as high as 80%.Methods. We have the clinical records of 61 patients diagnosed with MG at La Pat University Hospital, Madrid, Spain, from January 1977 to December 1994. All patients underwent thymectomy. The purpose of this investigation was to determine the major prognostic factors predicting MG outcome after operation.Results. Our results indicate that patients with a length of the disease from onset to operation shorter than 8 months have the best prognosis. Ossermann stages I and III are also associated with higher complete clinical remission rates. In contrast, neither age nor sex were found to be significantly related to MG outcome after thymectomy, although female patients have better prognosis than men, and the younger the patient the more likely is complete clinical remission. Pathologic findings after the operation were not found to be of prognostic value either.Conclusions. We conclude that thymectomy is a beneficial procedure for MG patients, with a complete clinical remission rate of 46% at 5 years postoperatively in our series. Therefore we advocate thymectomy for MG patients as early as possible in the course of disease because time elapsed from diagnosis to operation is the main determinant of the outcome. (C) 1999 by The Society of Thoracic Surgeons.