胸腔镜胸腺扩大切除术治疗重症肌无力的疗效观察及影响因素分析  

Efficacy of Video-assisted Thoracoscopic Thymectomy for Myasthenia Gravis and the Factors Influencing the Outcome

作　　者：崔健[1] 李剑锋[2] 周足力[2] 黄宇清[1] 陈应泰[1] 孟宪璞[1] 刘军[2] 王俊[2] 

机构地区：[1]北京市海淀医院胸外科,北京100080 [2]北京大学人民医院胸外科,北京100044

出　　处：《中国微创外科杂志》2012年第8期682-686,共5页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的对胸腔镜胸腺扩大切除术治疗重症肌无力(myasthenia gravis,MG)的疗效进行总结,分析影响MG手术疗效的因素。方法回顾性研究我院2000年6月～2009年10月47例MG接受胸腔镜手术的临床资料,采用单因素分析和logistic回归模型对患者性别、年龄、病程、MGFA分型、胸腺病理类型等可能影响因素进行分析。结果 45例完成随访,随访16～111个月,平均51个月。根据MGFA提出的治疗后状况分类:完全稳定缓解占64.4%(29/45),药物缓解占17.8%(8/45),微小症状表现占8.9%(4/45),恶化占2.2%(1/45),复发占4.4%(2/45),死亡占2.2%(1/45)。年龄(β=0.059,P=0.027,OR=1.060,95%CI为1.007～1.117)和胸腺病理类型(β=1.558,P=0.025,OR=4.750,95%CI为1.214～18.584)是影响手术疗效的因素。结论 MG行电视胸腔镜下胸腺扩大切除术疗效满意,年龄和胸腺病理类型是手术疗效的影响因素。Objective To assess the efficacy of and video-assisted thoracoscopie thymectomy in the treatment of myasthenia gravis （MG） and the factors influencing the results. Methods A total of 47 patients with MG, who underwent video-assisted thoracoscopic thymectomy in our hospital from June 2000 to October 2009, were enrolled in this retrospective study. The sex, age, course of disease, MGFA classification, and pathological type of thymus of the patients were analyzed with univariate and logistic regression analyses. Results Follow-up for a mean of 51 months （ranged from 16 to 111 months） was achieved in 45 of the 47 patients. Therapeutic regimen was determined based on the MGFA for the patients. After the treatment, 29 of the patients achieved complete stable remission （64.4%） , 8 had pharmacologic remission （17.8%） , 4 still had minimal manifestations （8.9%） , 1 was deteriorated （2.2%） , 2 showed recurrent MG （4.4%） , and 1 patient died （2.2%）. Age and pathological type of thymus were main factors influencing the outcomes of the treatment （ β = 0. 059, P = O. 027, OR = 1. 060, 95 % CI ： 1. 007 - 1.117, and β = 1. 558, P = 0. 025, OR = 4. 750, 95 % CI ： 1. 214 - 18. 584, respectively, P 〈 0.05）. Conclusion Video-assisted thoracoscopic thymectomy is effective for MG, age and pathological type of thymus are main factors influencing the outcomes of the operation.

关 键 词：胸腔镜 胸腺切除术 重症肌无力 胸腺瘤 

分 类 号：R655.7[医药卫生—外科学] R746.1[医药卫生—临床医学]