129例眼肌型重症肌无力的外科治疗  

Surgical treatment of ocular myasthenia gravis： a clinical analysis of 129 cases

作　　者：周景海[1] 王如文[1] 邓波[1] 月文科[1] 李坤[1] 李彦宁[1] 谭群友[1] 

机构地区：[1]第三军医大学大坪医院全军胸外科研究所胸外科,重庆400042

出　　处：《中华胸心血管外科杂志》2017年第3期144-147,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 总结和分析外科治疗眼肌型重症肌无力的效果及影响因素,为临床决策提供依据.方法 2007年5月至2014年11月胸腺切除治疗眼肌型重症肌无力129例,采用胸腔镜手术110例,胸骨部分劈开切口19例.术后经门诊及电话随访,疗效评定分为完全缓解、部分缓解、无效及恶化.采用x2检验及Cox回归模型进行统计学分析.结果 无围手术期死亡.手术并发症7例（5.4％）,治疗后均康复.术后随访123例,随访率95.3％,随访时间平均49（21～99）个月.123例中完全缓解40例,部分缓解68例,有效（完全缓解＋部分缓解）率87.8％;无效9例,恶化6例,无益（无效＋恶化）12.2％.6例恶化中4例转化为全身型,转化率3.3％.完全缓解组、部分缓解组与无益组之间术前病程≤24个月（P =0.004）及术后病理有无胸腺增生（P=0.001）,差异有非常显著意义;但性别、年龄、症状、有无并发症、术前应用胆碱酯酶抑制剂和糖皮质激素、手术径路和是否合并胸腺瘤无显著性差异.有效组与无益组间多因素回归分析显示术前病程≤24个月及术后病理为胸腺增生术后疗效更佳.结论 胸腺切除治疗眼肌型重症肌无力能有效缓解症状,避免或降低向全身型转化,并发症少,可作为眼肌型重症肌无力有效治疗方法.胸腔镜下胸腺切除创伤小、疼痛轻、恢复快,疗效与传统手术相近,值得推广.Objective Summing up and analyzing outcome and influencing factors following thymectomy in patients with ocular myasthenia gravis tries to provide clinical evidence for an option of the treatment modalities.Methods From May 2007 to November 2014,thymectomy was performed in 129 patients with ocular myasthenia gravis consisting of 110 patients by Video-assisted thoracoscopic surgery（VATS） and 19 by partial sternotomy.Follow-up information was obtained by outpatient visit and telephone contact.The outcome evaluation after thymectomy was classified into full remission,partial remission,unchanged and deteriorated.Statistical analysis was done using x2 test and Cox regression model.Results There was no perioperative death.Seven（5.4%） postoperative complications occurred and cured after treatment.Follow-up was complete in 123 patients（95.3%） and the mean duration of follow-up was 49（range 21-99） months.Surgical outcome revealed full remission in 40 patients,partial remission in 68,unchanged in 9 and deteriorated in 6 patients.Response（full remission and partial remission） rate was 87.8% and no benefit（unchanged and deteriorated） rate was 12.2%.Four of 6 patients in deteriorated condition progressed into generalized myasthenia gravis（3.3%）.The significant difference was noted in 24 months or less of preoperative clinical duration （P =0.004） and thymic hyperplasia （P =0.001） in postoperative pathology among the full remission,partial remission and no benefit group.On the other hand,there was no statistical difference in sex,age,symptoms,comorbidities,preoperative taking acetylcholinase inhibitor,corticosteroid,surgical approach,and associated thymona among the three groups.Multivariate Cox regression analysis also demonstrated that a preoperative duration of symptoms 24 months or less and postoperative histology being thymic hyperplasia favourably influenced the outcome.Conclusion The role of thymectomy in patients with ocular myasthenia gravis can relieve symptoms effectively and avert

关 键 词：眼肌型重症肌无力 外科治疗 胸腺切除 疗效 

分 类 号：R655.7[医药卫生—外科学]