Pérez-Nellar J, Negrín A, Llorens J A, Ferrá A, Pardo A, Parisi N
Servicio de Neurología, Hospital Clínico Quirúrgico Hermanos Ameijeiras, La Habana, Cuba.
Rev Neurol. 2000;30(9):801-6.
Thymectomy is a surgical procedure which is generally accepted for treatment of myasthenia gravis.
To describe the long-term evolution of 217 myasthenic patients who had had thymectomies in the Hospital Clinico Quirurgico Hermanos Ameijeiras in La Habana, Cuba.
We determined the stage of evolution of 217 patients, followed-up periodically, with an average observation time of 83.4 months and an interval of between 5 and 155 months. We also studied the frequency of remission and the influence of a group of variables on this, as well as the mortality and its causes.
The clinical state of the patients was: remission 77 (35.4%); pharmacological remission 45 (20.7%); significant improvement 70 (32.2%); the same or worse 5 (2.3%); deaths 11 (5%), and unknown 9 (4.1%). The cases with thymomas had a more unsatisfactory course than the other patients, with fewer remissions and greater mortality. Over the first five years of the evolution of the disease, there was a 30% rate of remission; after five years this rose to 35-40% and after ten years reached 47%. The age of the patient, duration of symptoms, histology of the thymus, age of onset of the disease and duration of follow-up did not have any significant effect (p < 0.05) on the long-term evolution of the thymectomy, in contrast to the gravity of the condition according to Osserman's scale.
The results of thymectomy, in our study were good and similar to the results reported in the international literature.
胸腺切除术是一种普遍被接受的治疗重症肌无力的外科手术。
描述在古巴哈瓦那的何塞·阿梅吉拉斯兄弟临床外科医院接受胸腺切除术的217例重症肌无力患者的长期病情演变。
我们确定了217例患者的病情演变阶段，对其进行定期随访，平均观察时间为83.4个月，随访间隔在5至155个月之间。我们还研究了缓解频率以及一组变量对缓解的影响，以及死亡率及其原因。
患者的临床状况为：缓解77例（35.4%）；药物缓解45例（20.7%）；显著改善70例（32.2%）；病情相同或恶化5例（2.3%）；死亡11例（5%），情况不明9例（4.1%）。胸腺瘤患者的病程比其他患者更不理想，缓解次数更少，死亡率更高。在疾病演变的前五年，缓解率为30%；五年后升至35 - 40%，十年后达到47%。患者年龄、症状持续时间、胸腺组织学、疾病发病年龄和随访时间对胸腺切除术的长期病情演变没有任何显著影响（p < 0.05），这与根据奥斯勒曼量表评估的病情严重程度形成对比。
在我们的研究中，胸腺切除术的结果良好，与国际文献报道的结果相似。
