Department of Thoracic Surgery, Mohamed V Military University Hospital, Faculté de Médecine et de Pharmacie Université Mohamed V Souissi, 10100 Rabat, Morocco.
Heart Lung Circ. 2013 Sep;22(9):738-41. doi: 10.1016/j.hlc.2013.02.010. Epub 2013 Mar 30.
Thymectomy is a surgical treatment of myasthenia gravis. Our goal is to report our experience in the surgical treatment of myasthenia gravis with or without thymoma and a review of the literature.
This is a retrospective study over a period of 10 years (2001-2010) on 43 patients: 28 women and 15 men with a mean age of 39.3 years (range 16-68 years). The myasthenia gravis was confirmed by clinical, electromyographic data and the presence of antibodies to acetylcholine receptors.
Computed tomography objectified thymic mass in 14 cases (32.5%) enlarged thymus without visible mass in eight cases (18.6%). All patients received anticholinesterase, cortico steroids in 25 cases and in three cases plasmapheresis was required. The surgical approach was total sternotomy (n=32 cases), cervicotomy (n=2), cervical and manubriotomy (n=1), a manubriotomy (n=3) and a thoracotomy in five cases (lateralised thymoma). All patients underwent a total thymectomy associated or not with resection of the tumour. Intensive Care Unit was necessary for at least 24h up to six days. The postoperative course was marked by a myasthaenic crisis (n=2) and respiratory failure (n=3) with a favourable outcome. The prognosis was marked by a complete remission in 14 cases, partial remission in 11 patients, stabilisation (n=16 cases) and increasing crisis in two patients.
Thymectomy certainly allows clinical improvement and reduced crisis of myasthenia gravis. Long term monitoring will confirm the benefit of non-oncological thymectomy alone or in combination with standard treatments for patients with generalised myasthenia gravis without thymoma.
胸腺切除术是重症肌无力的一种手术治疗方法。我们的目的是报告我们在伴或不伴胸腺瘤的重症肌无力的手术治疗经验，并对文献进行回顾。
这是一项回顾性研究，研究时间为 10 年（2001-2010 年），共纳入 43 例患者：28 例女性和 15 例男性，平均年龄 39.3 岁（16-68 岁）。重症肌无力通过临床、肌电图数据和乙酰胆碱受体抗体的存在得到确认。
14 例（32.5%）患者的计算机断层扫描显示胸腺肿块增大，8 例（18.6%）患者的胸腺增大但无可见肿块。所有患者均接受了抗胆碱酯酶药物、皮质类固醇治疗，25 例患者需要血浆置换。手术途径为全胸骨切开术（n=32 例）、颈切开术（n=2 例）、颈胸骨切开术（n=1 例）、胸骨切开术（n=3 例）和 5 例胸腔镜手术（侧胸腺瘤）。所有患者均行全胸腺切除术，伴或不伴肿瘤切除术。至少有 24 小时至 6 天需要入住重症监护病房。术后病程中出现 2 例肌无力危象和 3 例呼吸衰竭，均预后良好。14 例患者完全缓解，11 例患者部分缓解，16 例患者病情稳定（n=16 例），2 例患者病情恶化。
胸腺切除术确实可以改善临床症状并减少重症肌无力危象的发生。长期监测将证实非肿瘤性胸腺切除术单独或与标准治疗联合治疗伴或不伴胸腺瘤的全身性重症肌无力患者的获益。
