Digestive Diseases and Liver Transplantation Centre, Fundeni Clinical Institute, Bucharest, Romania.
Ann Surg. 2011 Nov;254(5):761-5; discussion 765-6. doi: 10.1097/SLA.0b013e31823686f6.
The aim of this study was to analyze the 10-year results of thoracoscopic unilateral extended thymectomy (TUET) performed in nontumoral myasthenia gravis according to the Myasthenia Gravis Foundation of America recommendations.
Thoracoscopic unilateral extended thymectomy has the benefits of a minimally invasive approach. Previous data have shown promising midterm results but long-term results were lacking.
Two hundred forty patients with nontumoral myasthenia gravis who underwent surgery between 1999 and 2009 were eligible for the study. The mean follow-up was of 67 months (range: 12-125), 134 patients completed follow-up assessments more than 60 months after TUET.
There were 39 males (16.3%) and 201 females (83.7%), with an age range from 8 to 60 years. The mean preoperative disease duration was 21.5 months. All patients underwent preoperative steroid therapy. Anticholinesterase drugs were required for 123 patients (51.3%), and immunosuppressive drugs were required for 87 (36.3%) patients. The pathologic findings were as follows: normal thymus in 13 patients (5.5%), involuted thymus in 65 patients (27%), and hyperplastic thymus in 162 patients (67.5%). The average weight of the thymus was 110 ± 45 g. Ectopic thymic tissue was found in 147 patients (61.3%). There was no mortality, and morbidity consisted of 12 patients (5%). Complete stable remission was achieved in 61% of the patients, and the cumulative probability of achieving complete stable remission was 0.88 at 10 years.
With zero mortality, low morbidity, and comparable long-term results to open surgery, TUET can be regarded as the best treatment option for patients undergoing surgery for myasthenia gravis.
本研究旨在分析根据美国重症肌无力基金会（MGFA）建议，对非肿瘤性重症肌无力患者施行胸腔镜下单侧扩大胸腺切除术（TUET）的 10 年结果。
胸腔镜下单侧扩大胸腺切除术具有微创优势。先前的数据显示出了有前景的中期结果，但缺乏长期结果。
1999 年至 2009 年间，240 例非肿瘤性重症肌无力患者符合入组研究条件。平均随访时间为 67 个月（范围：12-125 个月），134 例患者在 TUET 后超过 60 个月完成随访评估。
39 例为男性（16.3%），201 例为女性（83.7%），年龄范围为 8-60 岁。术前疾病平均病程为 21.5 个月。所有患者均接受术前类固醇治疗。123 例（51.3%）患者需要使用抗胆碱酯酶药物，87 例（36.3%）患者需要使用免疫抑制剂。病理发现：13 例（5.5%）为正常胸腺，65 例（27%）为退行性胸腺，162 例（67.5%）为增生性胸腺。胸腺平均重量为 110±45g。147 例（61.3%）患者发现异位胸腺组织。无死亡病例，发病率为 12 例（5%）。61%的患者获得完全稳定缓解，10 年时达到完全稳定缓解的累积概率为 0.88。
TUET 死亡率为零，发病率低，与开放性手术的长期结果相当，可作为重症肌无力患者手术治疗的最佳选择。
