Prokakis Christos, Koletsis Efstratios, Salakou Stavroula, Apostolakis Efstratios, Baltayiannis Nikolaos, Chatzimichalis Antonios, Papapetropoulos Theodoros, Dougenis Dimitrios
Cardiothoracic Surgery Department, School of Medicine, Patras University, Patras, Greece.
Ann Thorac Surg. 2009 Nov;88(5):1638-45. doi: 10.1016/j.athoracsur.2009.07.036.
Although thymectomy is a standard practice of care in patients with myasthenia gravis, the best approach to thymic resection remains controversial. This study was conducted to assess the effect of maximal resection on neurologic outcome and identify predictors of disease remission.
Data of 78 myasthenic patients who underwent modified maximal thymectomy during a 17-year period were retrospectively analyzed. The primary study end point was the achievement of complete remission. Separate analysis was performed for thymoma and nonthymoma patients regarding the factors predicting the neurologic outcome.
No patients died perioperatively. Surgical morbidity was 7.7%. The rate of postoperative myasthenic crisis was 3.8%. Thymoma and nonthymoma patients experienced comparable complete stable remission prediction (74.5% vs 85.7% at 15 years; p = 0.632). The absence of steroids in the preoperative medical treatment was statistically related to the prediction for complete stable remission in both thymoma (95% confidence interval [CI], 2.687 to 339.182, p = 0.006) and nonthymoma patients (95% CI, 1.607 to 19.183; p = 0.007) in multivariate analysis. In thymomatous myasthenia gravis, there was a statistically significant association between disease remission and the World Health Organization (WHO) histologic classification (95% CI, 0.262 to 0.827; p = 0.009).
Maximal resections are recommended in myasthenic patients. Disease severity represents the prime determinant of the neurologic outcome after thymectomy. The neurologic outcome in patients after thymectomy may be statistically associated with the WHO classification subtypes but not necessarily with the aggressiveness of these tumors.
尽管胸腺切除术是重症肌无力患者的标准治疗方法，但胸腺切除的最佳方式仍存在争议。本研究旨在评估最大限度切除对神经功能转归的影响，并确定疾病缓解的预测因素。
回顾性分析了78例在17年期间接受改良最大限度胸腺切除术的重症肌无力患者的数据。主要研究终点是实现完全缓解。针对胸腺瘤和非胸腺瘤患者，分别分析了预测神经功能转归的因素。
围手术期无患者死亡。手术并发症发生率为7.7%。术后重症肌无力危象发生率为3.8%。胸腺瘤和非胸腺瘤患者实现完全稳定缓解的预测情况相当（15年时分别为74.5%和85.7%；p = 0.632）。多因素分析显示，术前药物治疗中未使用类固醇与胸腺瘤患者（95%置信区间[CI]，2.687至339.182，p = 0.006）和非胸腺瘤患者（95%CI，1.607至19.183；p = 0.007）的完全稳定缓解预测具有统计学相关性。在胸腺瘤型重症肌无力中，疾病缓解与世界卫生组织（WHO）组织学分类之间存在统计学显著关联（95%CI，0.262至0.827；p = 0.009）。
建议对重症肌无力患者进行最大限度切除。疾病严重程度是胸腺切除术后神经功能转归的主要决定因素。胸腺切除术后患者的神经功能转归可能与WHO分类亚型存在统计学关联，但不一定与这些肿瘤的侵袭性相关。
