Department of Thoracic Surgery, Multidisciplinary Myasthenia Gravis Unit, Policlinico Tor Vergata University, Rome, Italy.
J Thorac Cardiovasc Surg. 2013 May;145(5):1319-24. doi: 10.1016/j.jtcvs.2012.12.053. Epub 2013 Jan 11.
The role of extended thymectomy in the treatment of class I myasthenia gravis is still controversial. This study compared the long-term outcomes of operated and nonoperated patients allocated according to their will.
We retrospectively reviewed 47 patients with class I nonthymomatous myasthenia gravis undergoing extended thymectomy between 1980 and 2007. These patients were matched with 62 class I patients who refused surgery and received only pharmacologic therapy. Outcomes were stable remission and clinical or pharmacologic improvement. Predictors of remission were analyzed by Kaplan-Meier and Cox regression.
We observed low postoperative major morbidity (n = 2; 4.2%) and no perioperative mortality. Heterotopic thymus was found in 22 patients (46%). Twenty-one patients showed active germinal centers, in the heterotopic thymus in 12 patients (57.1%). Thirty operated patients (64%) versus 34 nonoperated patients (55%) achieved stable remission, and 8 patients (17%) versus 5 patients (9%) showed pharmacologic improvement. Nine patients who had no postoperative improvement showed active ectopic thymus. Surgery was a marginal prognosticator (P = .053). Early treatment (≤6 months from symptoms onset) was the unique significant prognosticator (P = .045), but this was due to the contribution of the operated patients (P = .002). Other predictors of remission in the operated group were the absence of ectopic thymus (P = .007) with no germinal centers (P = .009). No significant predictor of remission was found in the nonoperated group.
Extended thymectomy achieved a more rapid remission than after nonsurgical treatment of class I myasthenia gravis. Significantly better outcomes resulted when thymectomy was performed within 6 months from the onset of symptoms.
扩展胸腺切除术在 I 型重症肌无力治疗中的作用仍存在争议。本研究比较了根据患者意愿进行手术和非手术治疗的患者的长期结果。
我们回顾性分析了 1980 年至 2007 年间接受扩展胸腺切除术的 47 例 I 型非胸腺瘤重症肌无力患者。这些患者与 62 例拒绝手术且仅接受药物治疗的 I 型患者相匹配。结果为稳定缓解和临床或药物改善。通过 Kaplan-Meier 和 Cox 回归分析缓解的预测因素。
我们观察到术后主要发病率低（n=2；4.2%），无围手术期死亡。22 例患者（46%）发现异位胸腺。12 例（57.1%）异位胸腺中有 21 例存在活跃的生发中心。30 例手术患者（64%）与 34 例非手术患者（55%）达到稳定缓解，8 例（17%）与 5 例（9%）出现药物改善。9 例术后无改善的患者存在活跃的异位胸腺。手术是一个边缘预后因素（P=0.053）。早期治疗（症状发作后≤6 个月）是唯一显著的预后因素（P=0.045），但这是由于手术组的贡献（P=0.002）。手术组缓解的其他预测因素是无异位胸腺（P=0.007）和无生发中心（P=0.009）。非手术组未发现缓解的显著预测因素。
扩展胸腺切除术比非手术治疗 I 型重症肌无力更能迅速缓解。在症状发作后 6 个月内进行手术，可获得更好的结果。
