Department of Thoracic Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing City, China.
Ann Thorac Surg. 2012 Jan;93(1):240-4. doi: 10.1016/j.athoracsur.2011.04.043. Epub 2011 Oct 5.
The treatment of patients with myasthenia gravis (MG) may include thymectomy. The objective of this study was to analyze the outcome of video-assisted thoracoscopic surgical (VATS) extended thymectomy and to compare characteristics of patients with MG with and without thymoma.
Between 2002 and 2009, 247 patients with MG underwent VATS thymectomy in our department and were subdivided into 2 groups: MG without thymoma (n=176) and MG with thymoma (n=71). Complete stable remission (CSR) was the primary endpoint for efficacy.
There were no intraoperative deaths and 4 cases required conversion to median sternotomy. There was a significant difference between the 2 groups regarding preoperative and postoperative myasthenic crisis. Two hundred nineteen patients were followed for 4 months to 9 years: 152 had thymoma and 67 did not have thymoma. The cumulative probabilities of reaching CSR were 37.5% in patients with MG without thymoma and 28.3% in patients with thymoma, respectively. Forty months after surgery there was no significant difference in CSR between the 2 groups. Two years after surgery, 30 patients without thymoma achieved CSR and disease was exacerbated in 2 patients after CSR had been achieved. Ten patients with thymoma achieved CSR, and exacerbation occurred in 5 patients with thymoma. Two patients without thymoma died of myasthenic crisis, whereas 3 of 4 patients with thymoma died of myasthenic crisis, and 1 death was attributable to recurrent disease.
Video-assisted thoracoscopic surgery thymectomy can produce a satisfactory long-term result. MG with thymoma seems more severe and its prognosis after thymectomy is not as optimistic as that of MG without thymoma. Special perioperative attention should be paid to patients with MG and thymoma to decrease the possibility of postoperative myasthenic crisis and reduce postoperative death.
重症肌无力（MG）患者的治疗可能包括胸腺切除术。本研究旨在分析胸腔镜辅助（VATS）扩大胸腺切除术的结果，并比较合并和不合并胸腺瘤的 MG 患者的特征。
2002 年至 2009 年，我科对 247 例 MG 患者行 VATS 胸腺切除术，分为 2 组：MG 无胸腺瘤组（176 例）和 MG 胸腺瘤组（71 例）。完全稳定缓解（CSR）是疗效的主要终点。
无术中死亡，4 例需转为正中开胸。2 组术前和术后肌无力危象有显著差异。209 例患者随访 4 个月至 9 年：152 例有胸腺瘤，67 例无胸腺瘤。MG 无胸腺瘤患者达到 CSR 的累积概率为 37.5%，MG 胸腺瘤患者为 28.3%。术后 40 个月时，2 组 CSR 无显著差异。术后 2 年，30 例无胸腺瘤患者达到 CSR，2 例 CSR 后病情加重。10 例胸腺瘤患者达到 CSR，5 例胸腺瘤患者病情加重。2 例无胸腺瘤患者死于肌无力危象，而 4 例胸腺瘤患者中有 3 例死于肌无力危象，1 例死亡归因于疾病复发。
胸腔镜辅助胸腺切除术可获得满意的长期效果。合并胸腺瘤的 MG 似乎更严重，其术后预后不如无胸腺瘤的 MG。MG 合并胸腺瘤患者应特别注意围手术期，降低术后肌无力危象的可能性，降低术后死亡率。
