Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Peoples' Republic of China.
Ann Thorac Surg. 2011 Dec;92(6):1993-9. doi: 10.1016/j.athoracsur.2011.08.001.
The optimal treatment for ocular myasthenia gravis (OMG) remains controversial. We conducted a review of the long-term clinical outcomes of Chinese patients with OMG after extended transsternal thymectomy (ETT) to determine the efficacy of this procedure as a treatment for OMG.
We reviewed the cases of 115 consecutive patients with OMG who underwent ETT at our Myasthenia Gravis Research Center between January 2006 and December 2008. Extended transsternal thymectomy was done in patients who had thymoma, resistance to pyridostigmine therapy, or relapse after immunosuppressive therapy. The patients' postoperative responses were defined as strict complete remission (SCR), consisting of an asymptomatic status without medication for more than 12 months; general complete remission (GCR), consisting of an asymptomatic status with low-dose single-drug therapy or without medication for more than 12 months; or improvement, consisting of fewer symptoms or less of a need for medication than before surgery.
The overall complication rate was 7.8%. None of the patients experienced a myasthenic crisis, progression to generalized myasthenia gravis, or mortality. Hyperplasia of the thymus was present in 106 of the 115 patients (92.2%). Among 110 patients on whom follow-up was done postoperatively, 29 (26.4%) were in SCR, 64 (58.2%) showed improvement, 7 (6.4%) remained unchanged, and 10 (9.1%) had a worsening of their conditions. Kaplan-Meier analysis revealed rates of GCR of 41.8% at 24 months and 47.3% at 48 months after surgery, and rates of SCR of 24.5% at 24 months and 26.4% at 48 months. Both univariate analysis and multivariate Cox regression analysis revealed that only preoperative duration of illness was positively associated with GCR (p < 0.001).
The results of the review indicate that ETT is a safe and effective treatment for OMG, especially in patients with illness of shorter duration.
眼肌型重症肌无力（OMG）的最佳治疗方法仍存在争议。我们对 115 例在中国肌无力研究中心接受胸骨后扩大胸腺切除术（ETT）的 OMG 患者进行了长期临床结局的回顾性研究，以确定该手术治疗 OMG 的疗效。
我们回顾了 2006 年 1 月至 2008 年 12 月期间在我院肌无力研究中心接受 ETT 的 115 例连续 OMG 患者的病例。在有胸腺瘤、对吡啶斯的明治疗有抵抗或免疫抑制治疗后复发的患者中进行胸骨后扩大胸腺切除术。患者的术后反应定义为严格完全缓解（SCR），包括无症状状态，无需药物治疗超过 12 个月；一般完全缓解（GCR），包括无症状状态，低剂量单一药物治疗或无需药物治疗超过 12 个月；或改善，包括症状减少或手术前药物需求减少。
总的并发症发生率为 7.8%。无患者发生肌无力危象、进展为全身型重症肌无力或死亡。115 例患者中有 106 例（92.2%）存在胸腺增生。110 例术后随访的患者中，29 例（26.4%）达到 SCR，64 例（58.2%）改善，7 例（6.4%）无变化，10 例（9.1%）病情恶化。Kaplan-Meier 分析显示，术后 24 个月和 48 个月时 GCR 分别为 41.8%和 47.3%，SCR 分别为 24.5%和 26.4%。单因素分析和多因素 Cox 回归分析均显示，只有术前病程与 GCR 呈正相关（p<0.001）。
本研究结果表明，ETT 是 OMG 的一种安全有效的治疗方法，尤其是在病程较短的患者中。
