13例重症肌无力胸腺扩大切除术疗效分析

目的探讨胸腺扩大切除术治疗重症肌无力的远期疗效以及影响预后的相关因素。方法回顾性分析1999年3月至2009年7月13例重症肌无力胸腺扩大切除术的病例资料以及术后的远期疗效。结果在平均为5年（0.5～10年）的随访期内,13例患者中完全缓解8例,部分缓解3例,无效2例,完全缓解率为61.5%,有效率为84.6%。不同性别、年龄的患者有效率差异无统计学意义。术前病程短和Ossermann分型为I型I、Ia型的患者有效率更高。术后病理中胸腺囊肿或增生者的有效率显著高于胸腺瘤者。结论胸腺扩大切除术治疗重症肌无力可以获得较好的疗效;术前病程、Osserman分型以及胸腺病理为胸腺瘤者可能是影响疗效的相关因素。

Long-term outcome after extended thymectomy for myasthenia gravis and analysis of prognostic factors

Objective To study the long-term outcome of extended thymectomy on myasthenia gravis(MG) and analyze the prognostic factors affecting surgical results.Methods We reviewed the data of 13 myasthenia gravis patients undergone extended thymectomy between March 1999 to July 2009.These patients'outcome and clinical features including gender,age,pre-operation duration of MG,modified Osserman Classification,pathology of thymus were evaluated by statistic method.Results The average follow-up period was 5.2 years(0.5～10years).Among the 13 patients,8 cases achieved complete remission,3 achieved partial remission and 2 had no effect at the last follow-up.The overall effectiveness rate was 84.6% and the complete remission rate was 61.5%.No significance was confirmed in the patients with different gender,age,pre-operation duration of MG or modified Osserman Classification.However,the overall effectiveness rate of patients without thymoma was higher than the patients with thymoma(100.0% vs 50.0%,p=0.018).Conclusion Extended thymectomy is effective for most myasthenia gravis.Pre-operation duration of MG,modified Osserman Classification,pathology of thymus may be the related prognostic factors for thymectomized myasthenia gravis.