Division of Thoracic Surgery, Department of Surgery, King Fahad Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Cardiothoracic surgery department, Faculty of Medicine, Menoufia University, Shibin Al Kawm, Al Minufiyah, Egypt.
Interact Cardiovasc Thorac Surg. 2022 Mar 31;34(4):584-589. doi: 10.1093/icvts/ivab295.
Our goal was to evaluate the effect of thymectomy on the progression of thymolipomatous myasthenia gravis.
An electronic search performed across PubMed, MEDLINE and Web of Science databases included all article types. We included 15 series comprising 36 cases that met specific criteria, including case reports or case series related to thymolipoma with a myasthenia gravis association, where thymectomy was cited as the primary intervention with postoperative reporting of the prognosis and articles written in the English language.
Our study included 17 men (47.2%) and 19 women (52.8%). Tumour sizes varied between 34 × 18 × 7 cm and 2.8 × 2.3 × 1.9 cm; the weight of the tumours ranged between 38 and 1780 g (mean 190, standard deviation 341). The surgical approaches were a median sternotomy in 29 patients (80.6%), a thoracotomy in 1 patient (2.8%), video-assisted thoracoscopic surgery in 2 patients (5.6%) and unreported approaches in 4 (11.1%) patients. The disease was entirely resolved with complete, stable remission in 5 patients (13.9%); symptoms were improved in 19 (52.8%) and stable in 10 patients (27.7%). We identified 2 groups of patients according to their improvement post-thymectomy (improved group and group with no change).
Although the cases were uncontrolled and did not demonstrate strong associations, they do support some hypotheses. We found a significant statistical difference between the 2 groups in terms of age, because younger patients tended to improve to a greater degree post-thymectomy. Also, we found that female patients with thymoma visible on the imaging scans were significantly associated with post-thymectomy myasthenia gravis improvement.
CRD42020173229.
评估胸腺切除术对胸腺瘤性重症肌无力进展的影响。
通过对 PubMed、MEDLINE 和 Web of Science 数据库进行电子检索，纳入了所有类型的文章。我们纳入了 15 个系列，共 36 例符合特定标准的病例，包括与胸腺瘤伴重症肌无力相关的病例报告或病例系列，其中胸腺切除术被列为主要干预措施，并报告了术后预后，以及用英文撰写的文章。
本研究纳入了 17 名男性（47.2%）和 19 名女性（52.8%）。肿瘤大小在 34×18×7cm 至 2.8×2.3×1.9cm 之间；肿瘤重量在 38 至 1780g 之间（平均 190，标准差 341）。手术入路包括 29 例（80.6%）正中胸骨切开术、1 例（2.8%）开胸术、2 例（5.6%）电视辅助胸腔镜手术和 4 例（11.1%）未报告的入路。5 例（13.9%）患者的疾病完全缓解，完全稳定缓解；19 例（52.8%）症状改善，10 例（27.7%）病情稳定。根据术后改善情况，我们将患者分为两组（改善组和无变化组）。
尽管这些病例没有对照，也没有显示出很强的关联，但它们确实支持了一些假说。我们发现两组患者在年龄方面存在显著的统计学差异，因为年轻患者术后往往改善程度更大。此外，我们发现女性患者和影像学检查可见胸腺瘤与术后重症肌无力改善显著相关。
PROSPERO 注册号：CRD42020173229。
