胸腔镜下胸腺扩大切除治疗非胸腺瘤重症肌无力  

Long-term results of video-assisted thoracoscopic extended thymectomy for non-thymomatous myasthenia gravis

作　　者：刘志艺[1] 林良安[1] 黄金龙[2] 杨建胜[1] 姜格宁 

机构地区：[1]福建医科大学附属第二医院胸外科,泉州362000 [2]福建医科大学附属泉州市第一医院胸外科 [3]同济大学附属上海市肺科医院

出　　处：《中华胸心血管外科杂志》2014年第8期479-481,487,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 评价胸腔镜下胸腺扩大切除治疗非胸腺瘤重症肌无力的中远期治疗效果并分析影响因素.方法 回顾112例胸腔镜下胸腺扩大切除术治疗非胸腺瘤重症肌无力患者的临床资料,其中男47例,女65例;年龄18～70岁,平均40.9岁.应用美国重症肌无力协会制定的治疗后状况分类评价术后治疗效果,采用Kaplan-Meier法及Cox回归模型分析各种可能的影响因素.结果 随访1.5～6.2年,平均3.2年,无失访.无加重及死亡病例,其中完全稳定缓解54例（48.2％）,药物缓解21例（18.8％）,微小症状表现10例（8.9％）,改善7例（6.3％）,无变化20例（17.8％）.多因素分析显示：年龄（P＜0.01,OR=3.468）、术前病程（P＜0.01,OR=3.203）、术后病理（P＜0.01,OR=3.064）是非胸腺瘤重症肌无力患者术后治疗效果的独立影响因素.结论 胸腔镜下胸腺扩大切除治疗非胸腺瘤重症肌无力治疗效果满意,年龄、术前病程及胸腺病理类型影响手术治疗效果.Objective The aims of this study were to assess the efficacy of video-assisted thoracoscopic extended thymectomy（VATET） as a treatment for non-thymomatous myasthenia gravis （NTMG） and to identify prognostic factors for thymectomy.Methods Retrospectively analyzed clinical datas of 112 patients received VATET for the treatment of NTMG.Clinical efficacy and variables influencing outcome were evaluated by Kaplan-Meier method and Cox proportional hazards regression analysis.Results At 3.2 years averaged （1.5-6.2 years） of follow-up,none of these patients were lost to follow up.According to the MGFA post-intervention status,54 patients（48.2%） obtained complete stable remission during follow-up,21 patients（18.8%） obtained pharmacologic remission,10 patients （8.9%） obtained minimal manifestations,7 patients （6.3%） improved,20 patients（17.8%） unchanged,and none of these patients were worse or died of MG.By multivariate analysis,the chance of complete stable remission was significantly increased when age 〈 40 years （P 〈 0.01,OR =3.468）,symptom duration 〈 12 months（P 〈 0.01,OR =3.203） and the presence of thymic hyperplasia （P 〈 0.01,OR =3.064）.Conclusion Video-assisted thoracoscopic extended thymectomy achieved satisfactory long-term results in patients with nonthymomatous myasthenia gravis,while age,symptom duration,the presence of thymic hyperplasia correlated with response to operation.

关 键 词：胸腔镜检查 胸腺切除术 重症肌无力 

分 类 号：R746.1[医药卫生—神经病学与精神病学]