胸骨后纵隔镜胸腺切除术治疗重症肌无力的长期疗效。
Long-term effects of infrasternal mediastinoscopic thymectomy in myasthenia gravis.
机构信息
Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
出版信息
J Neurol Sci. 2009 Dec 15;287(1-2):185-7. doi: 10.1016/j.jns.2009.08.002. Epub 2009 Sep 2.
BACKGROUND
Endoscopic thymectomy is commonly used for treatment of myasthenia gravis (MG) patients due to its relatively low invasiveness. However, the long-term effects of endoscopic thymectomy have not been fully evaluated.
OBJECTIVE
To assess the long-term effects of extended infrasternal mediastinoscopic thymectomy (IMT) in MG patients and compare them with those of extended transsternal thymectomy (TT).
METHODS
Among 24 MG patients without thymoma who underwent thymectomy in our Institute between January 1997 and December 2000, 14 patients who received IMT and 10 who received TT were enrolled in the present study. Quantitative myasthenia gravis (QMG) score and anti-acetylcholine receptor antibody (anti-AChR) titers were evaluated before and at five years after surgery.
RESULTS
After five years, QMG scores were reduced from 6.6 to 1.8 (p<0.01) in the IMT group, and from 7.6 to 2.7 (p<0.01) in the TT group. The anti-AChR titers were reduced from 75.2 to 40.1 (p=0.027) in the IMT group, and from 224 to 61.3 (p=0.020) in the TT group.
CONCLUSION
These data suggest that the long-term therapeutic effect of IMT is equivalent to TT, and is thus suitable for the treatment of MG patients.
背景
由于其相对较低的侵袭性，内镜胸腺切除术常用于治疗重症肌无力（MG）患者。然而，内镜胸腺切除术的长期效果尚未得到充分评估。
目的
评估扩展胸骨内胸腔镜胸腺切除术（IMT）在 MG 患者中的长期疗效，并与胸骨切开胸腺切除术（TT）进行比较。
方法
在 1997 年 1 月至 2000 年 12 月期间，我院共对 24 例无胸腺瘤的 MG 患者进行了胸腺切除术，其中 14 例患者接受了 IMT，10 例患者接受了 TT。在手术前和术后 5 年，对定量重症肌无力（QMG）评分和抗乙酰胆碱受体抗体（anti-AChR）滴度进行评估。
结果
5 年后，IMT 组的 QMG 评分从 6.6 降至 1.8（p<0.01），TT 组从 7.6 降至 2.7（p<0.01）。IMT 组的 anti-AChR 滴度从 75.2 降至 40.1（p=0.027），TT 组从 224 降至 61.3（p=0.020）。
结论
这些数据表明，IMT 的长期治疗效果与 TT 相当，因此适用于 MG 患者的治疗。
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