Andriescu L, Păcurariu M, Dănilă R, Antonoaie M, Dragomir C
Facultatea de Medicină Clinica a III-a Chirurgie, Universitatea de Medicină şi Farmacie Gr. T. Popa Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2001 Oct-Dec;105(4):769-72.
This study intends to assess the factors which may influence the surgical outcome in myasthenia gravis.
52 myasthenic patients were operated on in the IIIrd surgical unit, Iaşi, undergoing extended thymectomy through a complete longitudinal sternotomy during a period of 21 years (1980-2001), the surgical outcome being variable. The following factors: age, clinical stage (Osserman classification), the history length and the histopathology of the specimen were analysed in respect with the surgical outcome which varied from complete remission and clinical improvement till no effect and death. Out of 52 patients, 28 were under the age of 30 years and 24 above 30 years of age. 5 patients were operated on in the first clinical stage, 34 in the second clinical stage, 10 in the third stage and 3 in the fourth. 21 patients had had under 1 year history of the disease, 11 patients under 2 years and 20 patients over 2 years. 40 cases presented non-tumoral pathology of the thymus gland and 12 cases presented thymomas.
The best surgical results were recorded in patients under 30 years of age, operated in the first and second clinical stage, with a history under 1 year and non-tumoral pathology of the thymus.
Myasthenia gravis is the only one acquired autoimmune disease in which surgical treatment offers the chance of complete remission if the following criteria are encountered: young patient, short history, initial clinical stage and non-tumoral pathology.
本研究旨在评估可能影响重症肌无力手术效果的因素。
52例肌无力患者在雅西第三外科病房接受手术，在21年（1980 - 2001年）期间通过完全纵向胸骨切开术进行扩大胸腺切除术，手术效果各异。分析了以下因素：年龄、临床分期（奥斯勒曼分类）、病程长短以及标本的组织病理学，这些因素与手术效果相关，手术效果从完全缓解和临床改善到无效和死亡不等。52例患者中，28例年龄在30岁以下，24例年龄在30岁以上。5例患者处于第一临床阶段接受手术，34例处于第二临床阶段，10例处于第三阶段，3例处于第四阶段。21例患者病程不到1年，11例患者病程不到2年，20例患者病程超过2年。40例胸腺呈现非肿瘤性病理改变，12例呈现胸腺瘤。
30岁以下、处于第一和第二临床阶段、病程不到1年且胸腺为非肿瘤性病理改变的患者手术效果最佳。
重症肌无力是唯一一种获得性自身免疫性疾病，若满足以下标准：年轻患者、病程短、初始临床阶段且胸腺为非肿瘤性病理改变，手术治疗则有机会实现完全缓解。
