Kumar Arvind, Goyal Vinay, Asaf Belal B, Trikha Anjan, Sood Jayashree, Vijay C L
Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India.
Department of Neurology, All India Institiute of Medical Sciences, New Delhi, India.
Neurol India. 2017 Jan-Feb;65(1):58-63. doi: 10.4103/0028-3886.198211.
Context (Background): We report our experience with robotic thymectomy in patients with myasthenia gravis (MG)and provide data on the surgical results and neurologic outcomes, as per the Myasthenia Gravis Foundation of America (MGFA) recommendations for MG clinical research standards.
The study aims at reporting the surgical and neurological outcomes of patients of Myasthenia gravis treated by robotic thymectomy.
Prospective data was collected from 71 patients with myasthenia gravis (in the age range 15-67 years) with or without thymoma, who had completed a minimum follow up of one year. All patients were treated with robotic radical thymectomy. The clinical classification, status of preoperative and postoperative therapy, evaluation of post-interventional clinical status, and descriptions of morbidity/mortality were done as per the MGFA recommendations. Univariate and multivariate analysis was done to assess the factors associated with achievement of complete stable remission(CSR).
A total of 71 patients were included in this study. Twenty-one out of 71 patients (29.6%) with myasthenia gravis had thymoma. At the last follow up, 70 patients were alive. No evidence of tumour recurrence was found in patients with thymoma. The overall CSR rate was 38% with the median time to CSR of 17.5 months (range 11-48 months). The CSR rate for patient of MG with thymoma was 19 % (n=4/21). Factor found to be significantly predicting CSR were young age, lesser severity of MG and non-thymomatous histology.
Robotic thymectomy is a technically feasible and safe operation with a low morbidity and short hospitalization. It is associated with good neurological long-term results in terms of both CSR and clinical improvement.
背景：我们报告了机器人辅助胸腺切除术治疗重症肌无力（MG）患者的经验，并根据美国重症肌无力基金会（MGFA）关于MG临床研究标准的建议，提供手术结果和神经学结局的数据。
本研究旨在报告机器人辅助胸腺切除术治疗重症肌无力患者的手术和神经学结局。
前瞻性收集了71例年龄在15 - 67岁之间、有或无胸腺瘤的重症肌无力患者的数据，这些患者至少完成了一年的随访。所有患者均接受机器人根治性胸腺切除术。根据MGFA的建议进行临床分类、术前和术后治疗情况、介入后临床状态评估以及发病率/死亡率描述。进行单因素和多因素分析以评估与完全稳定缓解（CSR）达成相关的因素。
本研究共纳入71例患者。71例重症肌无力患者中有21例（29.6%）患有胸腺瘤。在最后一次随访时，70例患者存活。胸腺瘤患者未发现肿瘤复发迹象。总体CSR率为38%，达到CSR的中位时间为17.5个月（范围11 - 48个月）。伴有胸腺瘤的MG患者的CSR率为19%（n = 4/21）。发现显著预测CSR的因素为年轻、MG严重程度较低以及非胸腺瘤组织学类型。
机器人辅助胸腺切除术在技术上可行且安全，发病率低，住院时间短。在CSR和临床改善方面均具有良好的神经学长期结果。
