Hassantash S A, Ashbaugh D G, Verrier E D, Maier R V
Department of Surgery, Shahid Beheshti University, Tehran, Iran.
Thorax. 1996 Feb;51(2):193-6. doi: 10.1136/thx.51.2.193.
The results of thymectomy on patients with generalised myasthenia gravis have been widely reported. However, there is no information on whether the experience of western countries can be generalised to the population of the Middle East. The purpose of this study was to evaluate the safety and efficacy of thymectomy in patients with myasthenia gravis in a Middle East patient population and to identify clinical and histopathological factors associated with improved long term outcome of surgery.
In a prospective study, sixty three patients (aged 1.5-51 years) were treated in two university teaching hospitals between 1984 and 1991 and followed up for a mean of four years. Close communication was established with neurologists to obtain early referral. Radical anterior mediastinal dissection through a median sternotomy was performed in all patients. The response was evaluated by modified Osserman's classification.
Eighteen patients achieved complete remission and a further 39 improved, producing an overall response rate of 90.5%. Patients with milder disease (stage II) had a higher response rate (97%) than those with more advanced disease (78%). Patients operated on with less than three years of symptoms had a better outcome (94%) than those with longer duration of preoperative symptoms, especially in non-thymomatous patients. Age and sex had no effect on the outcome. There was no effect on response rate if patients had hyperplastic or non-specific thymic histological findings, but patients with thymoma fared worse.
These results are comparable with reports from the western world and represent the first prospective study from the Middle East. Thymectomy is indicated for all patients suffering from generalised myasthenia gravis soon after the diagnosis is made, regardless of age, stage, thymic pathology, and preoperative clinical status.
胸腺切除术治疗全身型重症肌无力患者的结果已有广泛报道。然而，尚无信息表明西方国家的经验是否可推广至中东人群。本研究旨在评估中东患者人群中行胸腺切除术治疗重症肌无力的安全性和有效性，并确定与手术长期疗效改善相关的临床和组织病理学因素。
在一项前瞻性研究中，1984年至1991年间，两所大学教学医院对63例患者（年龄1.5 - 51岁）进行了治疗，并平均随访四年。与神经科医生建立密切沟通以获得早期转诊。所有患者均通过正中胸骨切开术进行根治性前纵隔清扫。采用改良的奥斯勒曼分类法评估反应情况。
18例患者完全缓解，另有39例改善，总有效率为90.5%。病情较轻（II期）的患者有效率（97%）高于病情较重的患者（78%）。症状出现少于三年的患者手术效果（94%）优于术前症状持续时间较长的患者，尤其是非胸腺瘤患者。年龄和性别对结果无影响。患者胸腺组织学表现为增生或非特异性时，对有效率无影响，但胸腺瘤患者预后较差。
这些结果与西方世界的报道相当，是中东地区的首个前瞻性研究。对于所有诊断为全身型重症肌无力的患者，无论年龄、分期、胸腺病理及术前临床状况如何，均应在诊断后尽早行胸腺切除术。
