Surgery of Myasthenia Gravis Associated or Not With Thymoma: A Retrospective Study of 43 Cases
Surgery of Myasthenia Gravis Associated or Not With Thymoma: A Retrospective Study of 43 Cases
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DOI：
10.1016/j.hlc.2013.02.010
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发表时间：
2013-09-01
影响因子：
2.6
通讯作者：
Kabiri, El Hassane
中科院分区：
文献类型：
--
作者：
El Hammoumi, Massine;Arsalane, Adil;Kabiri, El Hassane
目的：胸腺切除术是治疗重症肌无力的一种手术方法。我们的目标是报告我们的经验，重症肌无力伴或不伴胸腺瘤的手术治疗和文献复习。材料和方法：这是一项回顾性研究，为期10年（2001-2010年）的43例患者：28名女性和15名男性，平均年龄为39.3岁（范围16-68岁）。结果：14例（32.5%）CT表现为胸腺肿块，8例（18.6%）胸腺增大，但未见肿块。所有患者均接受了抗胆碱酯酶、皮质类固醇治疗，其中25例患者需要血浆置换术。手术入路为全胸骨切开术（n = 32例）、颈部切开术（n = 2）、颈部和胸骨柄切开术（n = 1）、胸骨柄切开术（n = 3）和5例开胸术（偏侧胸腺瘤）。所有患者均行胸腺全切除术，或与肿瘤切除术无关。需要在重症监护室至少24小时，最长6天。术后病程以肌无力危象（n = 2）和呼吸衰竭（n = 3）为特征，结局良好。预后的特点是完全缓解14例，部分缓解11例，稳定（n = 16例）和增加危机在2 patients.Conclusion：胸腺切除术肯定可以改善临床和减少重症肌无力的危机。长期监测将证实非肿瘤胸腺切除术单独或联合标准治疗对无胸腺瘤的全身性重症肌无力患者的益处。(C)2013年澳大利亚和新西兰心脏和胸外科医师协会（ANZSCTS）和澳大利亚和新西兰心脏协会（CSANZ）。爱思唯尔公司出版All rights reserved.
Objectives: Thymectomy is a surgical treatment of myasthenia gravis. Our goal is to report our experience in the surgical treatment of myasthenia gravis with or without thymoma and a review of the literature.Materials and Methods: This is a retrospective study over a period of 10 years (2001-2010) on 43 patients: 28 women and 15 men with a mean age of 39.3 years (range 16-68 years). The myasthenia gravis was confirmed by clinical, electromyographic data and the presence of antibodies to acetylcholine receptors.Results: Computed tomography objectified thymic mass in 14 cases (32.5%) enlarged thymus without visible mass in eight cases (18.6%). All patients received anticholinesterase, cortico steroids in 25 cases and in three cases plasmapheresis was required. The surgical approach was total sternotomy (n = 32 cases), cervicotomy (n = 2), cervical and manubriotomy (n = 1), a manubriotomy (n = 3) and a thoracotomy in five cases (lateralised thymoma). All patients underwent a total thymectomy associated or not with resection of the tumour. Intensive Care Unit was necessary for at least 24 h up to six days. The postoperative course was marked by a myasthaenic crisis (n = 2) and respiratory failure (n = 3) with a favourable outcome. The prognosis was marked by a complete remission in 14 cases, partial remission in 11 patients, stabilisation (n = 16 cases) and increasing crisis in two patients.Conclusion: Thymectomy certainly allows clinical improvement and reduced crisis of myasthenia gravis. Long term monitoring will confirm the benefit of non-oncological thymectomy alone or in combination with standard treatments for patients with generalised myasthenia gravis without thymoma. (C) 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.