Marano E, Pagano G, Persico G, Striano S, Buscaino G A, Campanella G
Department of Neurology, School of Medicine, Federico II, University of Naples.
Acta Neurol (Napoli). 1993 Aug;15(4):277-88.
Forty-six patients with myasthenia gravis (MG) underwent transternal thymectomy between 1975 and 1991 and were observed over a long term follow up period (mean 6 years). Surgery was well tolerated and was followed in 32.6% of patients by remission of symptomatology. The severity of symptoms according to the Osserman scale was significantly reduced: slight forms of myasthenia increased soon after thymectomy more frequently than moderate and severe forms. Response to thymectomy at 3 months, according to the Hankins scale, was found to be positive (remission or amelioration of symptoms) in 31/41 patients, and worse in patients with thymoma. Probability of clinical remission and death were both significantly correlated with clinical response at three months after thymectomy. No other preoperatory clinical factor (onset age, sex, initial severity of MG, interval from symptom onset to thymectomy) was found to predict the response to treatment. Preoperatory mediastinic CT had a good reliability (> 85%) in diagnosing thymona, but was rarely able to distinguish between thymic hyperplasia and atrophy.
1975年至1991年间，46例重症肌无力（MG）患者接受了经胸骨胸腺切除术，并进行了长期随访（平均6年）。手术耐受性良好，32.6%的患者术后症状缓解。根据奥斯erman量表，症状严重程度显著降低：胸腺切除术后，轻度重症肌无力形式比中度和重度形式更频繁地在术后不久增加。根据汉金斯量表，术后3个月时，41例患者中有31例对胸腺切除术的反应为阳性（症状缓解或改善），胸腺瘤患者的反应较差。临床缓解概率和死亡概率均与胸腺切除术后3个月的临床反应显著相关。未发现其他术前临床因素（发病年龄、性别、MG初始严重程度、症状出现至胸腺切除的间隔时间）可预测治疗反应。术前纵隔CT在诊断胸腺瘤方面具有良好的可靠性（>85%），但很少能够区分胸腺增生和萎缩。
