Takanami Iwao, Abiko Tomohiro, Koizumi Satoko
Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2009 Dec;15(6):373-7.
Transsternal thymectomy is well established in the treatment of myasthenia gravis (MG). The objectives of this study were to evaluate the influence and prognostic factors of thymectomy as treatment for MG.
Surgical results of 54 patients with MG who underwent transsternal thymectomy were retrospectively reviewed. We investigated clinical outcomes of extended transsternal thymectomy in MG, and we analyzed the data to clarify the effect of prognostic factors on clinical outcome.
A total of 54 patients, including 28 males and 26 females, were analyzed. At their last visit, 5 patients (9%) were in complete remission; 36 (67%) reported clinical improvement; and 18 (33%) had no change. There were no operative or late deaths. Clinical improvement was not detected by a patient's age, sex, presence or absence of thymoma, or acetylcholine receptor (AchR) antibodies titer. Patients in which the duration of illness before operation was equal to or less than 24 months (p = 0.018), and patients in the advanced Myasthenia Gravis Foundation of America (MGFA) stage (p = 0.014), showed a greater degree of clinical improvement.
Transsternal thymectomy for MG is safe and effective. Those patients with severe symptoms and a shorter duration of illness showed more benefits from thymectomy.
经胸骨胸腺切除术在重症肌无力（MG）的治疗中已得到充分确立。本研究的目的是评估胸腺切除术作为MG治疗方法的影响及预后因素。
对54例行经胸骨胸腺切除术的MG患者的手术结果进行回顾性分析。我们研究了MG患者扩大经胸骨胸腺切除术的临床结果，并分析数据以阐明预后因素对临床结果的影响。
共分析了54例患者，其中男性28例，女性26例。在最后一次随访时，5例（9%）完全缓解；36例（67%）报告临床症状改善；18例（33%）无变化。无手术死亡或晚期死亡。患者的年龄、性别、是否存在胸腺瘤或乙酰胆碱受体（AchR）抗体滴度均未检测到临床改善。术前病程等于或小于24个月的患者（p = 0.018）以及美国重症肌无力基金会（MGFA）晚期的患者（p = 0.014）临床改善程度更大。
经胸骨胸腺切除术治疗MG安全有效。症状严重且病程较短的患者从胸腺切除术中获益更多。
