胸腺切除术治疗非胸腺瘤型重症肌无力：手术方法比较及预后因素分析。

Thymectomy for non-thymomatous myasthenia gravis: a comparison of surgical methods and analysis of prognostic factors.

机构信息

Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.

出版信息

Eur J Cardiothorac Surg. 2010 Jan;37(1):7-12. doi: 10.1016/j.ejcts.2009.05.027. Epub 2009 Jul 16.

DOI:10.1016/j.ejcts.2009.05.027

PMID:19615918

Abstract

OBJECTIVE

While thymectomy is an accepted treatment for myasthenia gravis (MG), video-assisted thoracoscopic surgery (VATS) thymectomy has recently become a popular surgical treatment, especially for non-thymomatous MG (NTMG). This study aims to compare the results of VATS thymectomy and trans-sternal thymectomy, and identify prognostic factors in NTMG patients after thymectomy.

METHODS

A 10-year retrospective review (January 1995 to December 2004) of 60 consecutive thymectomies (22 trans-sternal thymectomies and 38 VATS thymectomies) of NTMG patients performed in a university teaching hospital was undertaken.

RESULTS

There were 43 female patients and 17 male patients with a median MG-onset age of 25 years (range: 5-78 years). Median follow-up time was 44 months. VATS thymectomy patients had a shorter hospital stay than the trans-sternal thymectomy patients (5.6 days vs 8.1 days, p=0.008). There was no other statistically significant difference between the two operative methods in NTMG patients, including intensive care unit (ICU) stay, ventilator support time, operative time, postoperative status, complete stable remission (CSR) rate, morbidity and mortality. Three prognostic factors associated with better remission rate were hyperthyroidism (p=0.003), age <40 years (p=0.022) and the presence of thymic hyperplasia (p=0.041). Other factors, including gender, disease duration, preoperative MG severity, acetylcholine receptor antibody, perioperative therapy and operative methods (32% vs 36%, p=0.91, 95% confidence interval (CI)=0.27-3.21) were not statistically relevant to better remission rate.

CONCLUSIONS

VATS thymectomy is more advantageous for NTMG patients because of shorter hospital stay, less tissue injury, better cosmetic result and equivalent CSR rate. NTMG patients aged <40 years with hyperthyroidism and a histologic diagnosis of lymphofollicular hyperplasia have better chances of remission after thymectomy.

摘要

目的

胸腺切除术是重症肌无力（MG）的一种公认治疗方法，而电视辅助胸腔镜手术（VATS）胸腺切除术最近已成为一种流行的手术治疗方法，尤其适用于非胸腺瘤性 MG（NTMG）。本研究旨在比较 VATS 胸腺切除术和胸骨正中切开术的结果，并确定 NTMG 患者胸腺切除术后的预后因素。

方法

对 1995 年 1 月至 2004 年 12 月在一所大学教学医院进行的 60 例连续 NTMG 患者（22 例胸骨正中切开术和 38 例 VATS 胸腺切除术）进行了 10 年回顾性研究。

结果

43 例为女性患者，17 例为男性患者，中位 MG 发病年龄为 25 岁（范围：5-78 岁）。中位随访时间为 44 个月。VATS 胸腺切除术患者的住院时间短于胸骨正中切开术患者（5.6 天 vs 8.1 天，p=0.008）。在 NTMG 患者中，两种手术方法在重症监护病房（ICU）入住时间、呼吸机支持时间、手术时间、术后状态、完全稳定缓解（CSR）率、发病率和死亡率方面均无统计学差异。与更好的缓解率相关的三个预后因素是甲状腺功能亢进症（p=0.003）、年龄<40 岁（p=0.022）和存在胸腺增生（p=0.041）。其他因素，包括性别、疾病持续时间、术前 MG 严重程度、乙酰胆碱受体抗体、围手术期治疗和手术方法（32% vs 36%，p=0.91，95%置信区间（CI）=0.27-3.21）与更好的缓解率无统计学相关性。