| 摘要 |
In the present study, the role of thymectomy in the treatment of myas-thenia gravis (MG) has been analysed for 70 simple or thymomatous MG patients that underwent surgical intervention between July, 1983 and May, 1994. A total of 25 males and 45 females, with a mean age of 36.9+14.6 years, constituted the sample. Of these, twenty three (33.9%) patients had concur- rent thymoma (thymomatous MG), the diagnosis of which was confirmed on the basis of clinical symptoms, Tensilon test, electrophysiological studies or serum acetylcholine receptor antibody (AchR) titer. Also, chest computed tomography was performed to detect the existence of thymoma, and clinical MG staging was determined preoperatively and monitored during the follow-up period. Transsternal extended thymectomy (including mediastinal fat dissection) was undertaken for patients with simple MG, whereas thymothymectomy through sternotomy or sternothoracotomy was undertaken for ones with thymomatous MG. No postoperative death was
noted and only two patients, showing MG symptoms, needed prolonged ventilatory support (>7 days) postoperatively. However, two patients died of thymoma recurrence or metastasis. The outcome (remission and surgical beneficial curve) was analyzed, and the possible influencing factor such as age, sex, existence of thymoma, MG duration before thymectomy, MG staging or the pathology of thymus, was analyzed based on the univariate and multivariate Cox model. The surgical remission and beneficial rates for the presant patients, at the end of follow-up period, are 35.7% and 87.1% respectively, and the existence of thymoma is found to be the single most significant factor of which adversely influences the outcome. In this series it was also found that younger (<40 years old) or female patients have significantly higher possibility of acquiring simple MG, than the male or older patients. It may hence be concluded that thymectomy is an effective treatment for patients with MG, and also that patients with thymomatous MG are likely to suffer a worse outcome than the ones with simple MG. |
