Fischer J E, Grinvalski H T, Nussbaum M S, Sayers H J, Cole R E, Samaha F J
Ann Surg. 1987 May;205(5):496-503. doi: 10.1097/00000658-198705000-00007.
A series of 27 patients with generalized myasthenia gravis is presented. All patients were treated by a sternal split and extended thymectomy and radical mediastinal dissection. The overall drug-free remission rate was 63%, although three additional patients are likely to achieve drug-free remission in the near future, with the total drug-free remission rate then being 74%. Of the remaining patients, all but three improved and require decreased medication, for an improvement rate of approximately 90%. One patient who has not improved had an invasive malignant thymoma. Drug-free remission was achieved in 46% of the male patients and in 82% of the female patients despite that the mean duration of disease was greater than 3.5 years. There was one serious complication, that of sterile sternal dehiscence. There was no mortality. The results suggest that an aggressive, radical surgical approach to myasthenia gravis, even in a group of patients considered somewhat less favorable because of a relatively long duration of disease, can result in a high percentage of drug-free remissions. Radical surgery for myasthenia gravis appears to be the treatment of choice, with medical therapy being reserved for those patients who are not likely to survive operation.
本文报告了27例全身型重症肌无力患者。所有患者均接受胸骨劈开扩大胸腺切除术及根治性纵隔清扫术。总体无药缓解率为63%，另外3例患者近期可能实现无药缓解，届时总无药缓解率将达74%。其余患者中，除3例未改善外，均有好转且所需药物剂量减少，改善率约为90%。1例未改善的患者患有侵袭性恶性胸腺瘤。尽管平均病程超过3.5年，但男性患者的无药缓解率为46%，女性患者为82%。发生了1例严重并发症，即无菌性胸骨裂开。无死亡病例。结果表明，对于重症肌无力，即使是一组因病程相对较长而被认为预后稍差些的患者，积极的根治性手术方法也可导致高比例的无药缓解。重症肌无力的根治性手术似乎是首选治疗方法，药物治疗则保留给那些手术可能无法存活的患者。
