Extended Transsternal Thymectomy for the Treatment of Ocular Myasthenia Gravis
Extended Transsternal Thymectomy for the Treatment of Ocular Myasthenia Gravis
复制标题
扩大经胸骨胸腺切除术治疗眼部重症肌无力。
DOI：
10.1016/j.athoracsur.2011.08.001
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发表时间：
2011-12-01
影响因子：
4.6
通讯作者：
Cheng, Chao
中科院分区：
文献类型：
--
作者：
Liu, Zhenguo;Feng, Huiyu;Cheng, Chao
背景资料。眼肌无力(OMG)的最佳治疗方案仍存在争议。我们回顾了中国OMG患者扩大经胸骨胸腺切除术(ETT)后的远期临床结果，以确定该手术治疗OMG的疗效。我们回顾了2006年1月至2008年12月在我们的重症肌无力研究中心连续接受ETT的115例OMG患者。胸腺瘤、吡斯的明治疗耐药或免疫抑制治疗后复发的患者可接受扩大胸骨胸腺切除术。患者的术后反应定义为严格完全缓解(SCR)，包括未用药超过12个月的无症状状态；一般完全缓解(GCR)，包括接受小剂量单一药物治疗或未用药超过12个月的无症状状态；或好转，包括症状减少或不需要药物治疗。总的并发症发生率为7.8%。无一例患者出现肌无力危象、进展为全身性重症肌无力或死亡。115例患者中有106例(92.2%)出现胸腺增生。术后随访29例(26.4%)处于SCR状态，(58.2%)好转，7例(6.4%)无变化，10例(9.1%)病情恶化。Kaplan-Meier分析显示术后24个月和48个月GCR率分别为41.8%和47.3%，SCR率分别为24.5%和26.4%。单因素分析和多因素COX回归分析均显示只有术前病程与GCR呈正相关(p<；0.001)。综述结果表明，ETT是治疗OMG的一种安全有效的治疗方法，尤其是对病程较短的患者。(Ann Thorac Surg 2011；92：1993-9)(C)2011年，胸外科学会
Background. The optimal treatment for ocular myasthenia gravis (OMG) remains controversial. We conducted a review of the long-term clinical outcomes of Chinese patients with OMG after extended transsternal thymectomy (ETT) to determine the efficacy of this procedure as a treatment for OMG.Methods. We reviewed the cases of 115 consecutive patients with OMG who underwent ETT at our Myasthenia Gravis Research Center between January 2006 and December 2008. Extended transsternal thymectomy was done in patients who had thymoma, resistance to pyridostigmine therapy, or relapse after immunosuppressive therapy. The patients' postoperative responses were defined as strict complete remission (SCR), consisting of an asymptomatic status without medication for more than 12 months; general complete remission (GCR), consisting of an asymptomatic status with low-dose single-drug therapy or without medication for more than 12 months; or improvement, consisting of fewer symptoms or less of a need for medication than before surgery.Results. The overall complication rate was 7.8%. None of the patients experienced a myasthenic crisis, progression to generalized myasthenia gravis, or mortality. Hyperplasia of the thymus was present in 106 of the 115 patients (92.2%). Among 110 patients on whom follow-up was done postoperatively, 29 (26.4%) were in SCR, 64 (58.2%) showed improvement, 7 (6.4%) remained unchanged, and 10 (9.1%) had a worsening of their conditions. Kaplan-Meier analysis revealed rates of GCR of 41.8% at 24 months and 47.3% at 48 months after surgery, and rates of SCR of 24.5% at 24 months and 26.4% at 48 months. Both univariate analysis and multivariate Cox regression analysis revealed that only preoperative duration of illness was positively associated with GCR (p < 0.001).Conclusions. The results of the review indicate that ETT is a safe and effective treatment for OMG, especially in patients with illness of shorter duration. (Ann Thorac Surg 2011;92:1993-9) (C) 2011 by The Society of Thoracic Surgeons