经胸骨胸腺扩大切除治疗重症肌无力143例分析

目的探讨经胸骨正中切口胸腺切除术治疗重症肌无力（MG）的效果及其预后因素。方法对1994-2005年接受了经胸骨正中切口胸腺切除术治疗MG的143例患者接受了回顾性分析。对完全稳定缓解（CSR）率及其相关的影响因素进行评价。结果平均年龄为36岁（10-73岁）。95例为非胸腺瘤型,48例为胸腺瘤型。平均随访时间86.2个月（16-161个月）。非胸腺瘤型MG与胸腺瘤型MG在临床特点和CSR率上有显著性差异（5年CSR率的比例前者为29.2%,后者为13.1%;10年CSR率前者为43.6%,后者为26.8%,P=0.023）。在非胸腺瘤型MG中,接受过激素治疗为预后不良的因素（危险度比：0.231,P=0.003）,而早期的发病年龄是预后良好的因素（危险度比：3.516,P=0.047）。在胸腺瘤型MG中,接受过激素治疗为预后不良因素（危险度比：0.060,P=0.032）。结论经胸骨正中切口行胸腺扩大切除是治疗MG的一种安全有效的手术方式,胸腺瘤型MG和非胸腺瘤型MG在临床特点和预后上显著不同,在非胸腺瘤型MG中,预后因素为激素治疗和发病年龄,在胸腺瘤型MG中,预后因素为激素治疗。

Extended transsternal thymectomy for myasthenia gravis

Objective This study was to determine the efficacy and prognostic factors of extended transsternal thymectomy to treat myasthenia gravis（MG）.Methods Medical records of 143 patients underwent extended transsternal thymectomy for MG were retrospectively reviewed.The complete stable remission（CSR） rate and prognostic factors for CSR were assessed.Results 95 patients had non-thymomatous MG and 48 patients had thymomatous MG.Both non-thymomatous MG and thymomatous MG exhibited significant differences in population characteristics and CSR rates（29.2% vs 13.1% at 5 years,43.6% vs 26.8% at 10 years,P=0.023）.Steroid therapy（hazard ratio：0.231,P=0.003） was a poor prognostic factor,while early onset（hazard ratio： 3.516,P=0.047） was a good prognostic factor for CSR in non-thymomatous MG.In contrast,steroid therapy（hazard ratio： 0.060,P=0.032） was poor prognostic factor for thymomatous MG.Conclusion Extended transsternal thymectomy is a good treatment to achieve CSR in MG.Thymomatous MG and non-thymomatous MG were significantly different in patient characteristics and prognosis.Prognostic factors were steroid therapy and age of onset in non-thymomatous MG,and steroid therapy in thymomatous MG.