Busch C, Machens A, Pichlmeier U, Emskötter T, Izbicki J R
Department of Surgery, University of Hamburg, Germany.
Ann Surg. 1996 Aug;224(2):225-32. doi: 10.1097/00000658-199608000-00017.
The authors identify criteria suitable to predict long-term clinical improvement and evaluate quality of life after thymectomy for myasthenia.
Retrospective analysis with long-term follow-up (mean 92 months) was conducted for 86 patients and questionnaire interviews were performed for 65 patients who underwent thymectomy between 1976 and 1993.
The authors used the Osserman Score and the European Organization for Research and Treatment of Cancer quality-of-life questionnaire.
After thymectomy, lasting benefits were achieved predominantly by patients with moderate and severe myasthenia, and this association was significant (p < 0.001) in both bivariable and multiple analyses. No correlation was observed between outcome and thymic pathology, patient age or gender, duration of disease, preoperative plasmapheresis, and medication. Restitution to normal was complete at most recent follow-up as to physical status, working ability, and cognitive and social functions, but some emotional and vegetative deficits remained.
Future patient selection for thymectomy should-apart from those with suspected thymoma-concentrate on patients with moderate and severe myasthenia unresponsive to conservative management.
作者确定适合预测重症肌无力患者胸腺切除术后长期临床改善情况及评估生活质量的标准。
对86例患者进行了长期随访（平均92个月）的回顾性分析，并对1976年至1993年间接受胸腺切除术的65例患者进行了问卷调查。
作者采用奥斯默曼评分法和欧洲癌症研究与治疗组织生活质量问卷。
胸腺切除术后，中度和重度重症肌无力患者主要获得了持久益处，在双变量和多变量分析中，这种关联均具有显著性（p<0.001）。未观察到结果与胸腺病理、患者年龄或性别、病程、术前血浆置换及用药之间存在相关性。在最近一次随访中，身体状况、工作能力以及认知和社会功能已完全恢复正常，但仍存在一些情感和植物神经功能缺陷。
未来胸腺切除术的患者选择，除疑似胸腺瘤患者外，应集中于对保守治疗无反应的中度和重度重症肌无力患者。
