Papatestas A E, Genkins G, Kornfeld P, Eisenkraft J B, Fagerstrom R P, Pozner J, Aufses A H
Ann Surg. 1987 Jul;206(1):79-88. doi: 10.1097/00000658-198707000-00013.
Factors influencing onset of remission in myasthenia gravis were evaluated in 2062 patients, of whom 962 had had thymectomy. Multivariate analysis showed that appearance of early remissions among all patients was significantly and independently influenced by thymectomy, by milder disease, and by absence of coexisting thymomas. Patients with mild generalized symptoms treated with thymectomy reached remission more frequently, even when compared with those with ocular myasthenia treated without surgery. Short duration of disease before thymectomy in mild cases was another factor associated with earlier remissions. Mortality for all patients was significantly and independently influenced by severity of symptoms, age, associated thymomas, and failure to remove the thymus. Patients without thymectomy and with thymomas had, in addition, earlier onset of extrathymic neoplasms. Morbidity after the transcervical approach was minimal. This study demonstrates that early thymectomy by the transcervical approach, when technically feasible, has significant clinical advantages over the transthoracic approach and should be advocated for all patients with myasthenia gravis, including those with ocular disease.
对2062例重症肌无力患者的缓解期起始影响因素进行了评估，其中962例行胸腺切除术。多变量分析显示，所有患者中早期缓解的出现受到胸腺切除术、病情较轻以及无并存胸腺瘤的显著且独立的影响。接受胸腺切除术治疗的轻度全身症状患者更频繁地达到缓解，即使与未接受手术治疗的眼肌型重症肌无力患者相比也是如此。轻度病例中胸腺切除术前病程较短是与较早缓解相关的另一个因素。所有患者的死亡率受到症状严重程度、年龄、并存胸腺瘤以及未切除胸腺的显著且独立的影响。此外，未行胸腺切除术且患有胸腺瘤的患者胸外肿瘤发病较早。经颈部入路术后发病率极低。本研究表明，当技术可行时，经颈部入路早期胸腺切除术比经胸入路具有显著的临床优势，应推荐用于所有重症肌无力患者，包括眼部疾病患者。
