Blossom G B, Ernstoff R M, Howells G A, Bendick P J, Glover J L
Department of Surgery, William Beaumont Hospital, Royal Oak, Mich.
Arch Surg. 1993 Aug;128(8):855-62. doi: 10.1001/archsurg.1993.01420200029005.
To assess the change in clinical status of patients with generalized myasthenia gravis treated with thymectomy and to identify prognostic variables that may be of significance in optimizing patient selection.
Retrospective review. Mean follow-up period was 41 months.
Large community hospital.
Thirty-seven patients (11 male and 26 female) with generalized myasthenia gravis who were referred for thymectomy if they were refractory to medical treatment or had a thymoma. This represents all patients undergoing thymectomy for myasthenia gravis between January 1982 and December 1991.
Each patient underwent staging before and after thymectomy using a modified Osserman classification. Medication requirements were also recorded. All patients underwent transsternal thymectomy and complete mediastinal dissection.
Changes in clinical stage and medication requirement before and after thymectomy; effect of patient age, sex, duration of disease, stage of disease, antibody status, histologic characteristics of the thymus, and duration of follow-up on outcome.
Improvement after thymectomy was noted in all 37 patients. Complete remission was achieved in three patients (8%) and pharmacologic remission in 23 (62%). The remainder improved in stage, medication requirement, or both. Patients in preoperative stages IIb and IIc showed the greatest improvement. Age, sex, duration of disease, antibody status, histologic characteristics of the thymus, and duration of follow-up were not significant factors in assessing improvement.
Transsternal thymectomy was found to be beneficial to all patients with generalized myasthenia gravis. Complete or pharmacologic remission was achieved in most patients (70%) following the procedure. Patients in preoperative stages IIb and IIc showed the greatest degree of postoperative improvement.
评估接受胸腺切除术的全身型重症肌无力患者的临床状态变化，并确定在优化患者选择方面可能具有重要意义的预后变量。
回顾性研究。平均随访期为41个月。
大型社区医院。
37例全身型重症肌无力患者（11例男性，26例女性），如果他们对药物治疗无效或患有胸腺瘤，则被转诊接受胸腺切除术。这代表了1982年1月至1991年12月期间所有因重症肌无力接受胸腺切除术的患者。
每位患者在胸腺切除术前和术后使用改良的奥斯勒曼分类法进行分期。还记录了药物需求。所有患者均接受经胸骨胸腺切除术和完整的纵隔清扫术。
胸腺切除术前和术后临床分期及药物需求的变化；患者年龄、性别、病程、疾病分期、抗体状态、胸腺组织学特征以及随访时间对结局的影响。
37例患者术后均有改善。3例患者（8%）实现完全缓解，23例患者（62%）实现药物缓解。其余患者在分期、药物需求或两者方面均有改善。术前IIb期和IIc期患者改善最为明显。年龄、性别、病程、抗体状态、胸腺组织学特征以及随访时间在评估改善情况时并非显著因素。
发现经胸骨胸腺切除术对所有全身型重症肌无力患者均有益。术后大多数患者（70%）实现了完全或药物缓解。术前IIb期和IIc期患者术后改善程度最大。
