胸腺切除术在治疗重症肌无力中的价值

目的了解采用胸腺切除术治疗的重症肌无力患者的术后临床过程,确认可能影响术后疗效的预后因素。方法对经胸骨正中切口行胸腺切除术治疗的９１例重症肌无力病人,进行定期随访,以ＫａｐｌａｎＭｅｉｅｒ方法计算５年缓解和改善概率。结果症状缓解３６例,改善２７例,无变化１４例,恶化１４例,５年总体缓解和改善概率分别为６４％和８８％。结论大多数重症肌无力病人的症状随术后时间的延长而得到改善,这可能与胸腺切除和病史自然发展的自限性有关。胸腺切除术后的病程变化受病人手术时的年龄,性别,病程的长短和病理分型等因素的影响

Thymectomy in the treatment of myasthenia gravis

OBJECTIVES: To review the clinical course of patients with myasthenia gravis following thymectomy and to identify prognostic factors that may influence outcome. METHODS: We follow-up 91 patients with myasthenia gravis surgically treated with thymectomy through a median stereotomy from May, 1983 to October, 1993. The overall 5-year remission and improvement probabilities were obtained by Kaplan-Meier Method. RESULTS: 36 (39.6%) patients showed remission, 27 (29.7%) improvement, 14 (15.4%) no change and 14 (15.4%) worsening. The overall 5-year remission and improvement probabilities of patients were 64% and 88% respectively. CONCLUSIONS: Most patient's symptoms after thymectomy were progressively improved with time, which is probably attributable to thymectomy, and the natural history of myasthenia gravis. Age at surgery, sex, duration of clinical course and pathological findings may be important prognostic factors for patients with myasthenia gravis after thymectomy.