Witoonpanich Rawiphan, Dejthevaporn Charungthai, Srisinroongruang Theerayuth, Subhannachart Wises, Attanavanich Sukasom, Boonkasem Somboon, Thakkinstian Ammarin
Division of Neurology, Department of Medicine, Ramathibodi Hospital, Rama 6 Road, Bangkok 10400, Thailand.
J Med Assoc Thai. 2004 Oct;87(10):1172-5.
Thymectomy has gained widespread acceptance as a treatment for patients with myasthenia gravis (MG). Patients with myasthenia gravis who had undergone thymectomy by extended transsternal approach between 1981 and 1987 were retrospectively reviewed to evaluate the result of thymectomy, time to remission, time to maximum improvement and factors influencing remission after thymectomy. There were 128 patients, 45 men and 83 women and the mean ages at the time of thymectomy were 35.7 and 32.2 years respectively. After thymectomy, 41.2% of the patients were in remission, 53% improved and 5.8% had no response. The remission rates at 1, 2, 5 and 10 years after thymectomy were 9%, 17%, 37% and 53% respectively and the median time to remission was 9 years. The maximum improvement rates at 1, 2, 5 and 10 years after thymectomy were estimated to be 30%, 40%, 57% and 78% respectively and the median time to maximum improvement was 3.6 years. Patients with ocular MG, longer duration of symptoms before thymectomy and atrophic thymus gland appeared to take longer to achieve remission although none of the factors was significantly associated with the time to remission. Thymectomy is beneficialfor MG patients with satisfactory remission and improvement rates. It is recommended that thymectomy should be advocatedfor these patients early in the course of the disease because the duration of the symptoms appeared to be the main determinant of the outcome.
胸腺切除术已被广泛认可为治疗重症肌无力（MG）患者的一种方法。对1981年至1987年间采用扩大经胸骨入路进行胸腺切除术的重症肌无力患者进行回顾性研究，以评估胸腺切除术的效果、缓解时间、最大改善时间以及影响胸腺切除术后缓解的因素。共有128例患者，其中男性45例，女性83例，胸腺切除时的平均年龄分别为35.7岁和32.2岁。胸腺切除术后，41.2%的患者病情缓解，53%有所改善，5.8%无反应。胸腺切除术后1年、2年、5年和10年的缓解率分别为9%、17%、37%和53%，缓解的中位时间为9年。胸腺切除术后1年、2年、5年和10年的最大改善率估计分别为30%、40%、57%和78%，最大改善的中位时间为3.6年。眼肌型重症肌无力患者、胸腺切除术前症状持续时间较长以及胸腺萎缩的患者似乎需要更长时间才能达到缓解，尽管这些因素均与缓解时间无显著相关性。胸腺切除术对重症肌无力患者有益，缓解率和改善率令人满意。建议在疾病早期就对这些患者提倡胸腺切除术，因为症状持续时间似乎是预后的主要决定因素。
