Benefits of early thymectomy in patients with myasthenia gravis.

J Bramis, E Pikoulis, A Leppäniemi, E Felekouras, D Alexiou, E Bastounis
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Abstract

Objective: To report our experience of early thymectomy in patients with myasthenia gravis.

Design: Retrospective study.

Setting: University department of surgery, Greece.

Subjects: 76 Patients with myasthenia gravis.

Interventions: Transcervical thymectomy in all cases, additional left thoracotomy in four cases.

Main outcome measures: Mortality, morbidity, and early (6 months) and late (mean follow-up 4.8 years) response to thymectomy.

Results: 20 Patients had thymomas (26%). There was no postoperative mortality; morbidity was 11% (n = 8). There was complete remission in 19 (25%), improvement in 49 (65%) no change in 7 (9%), and impairment in 1 (1%) of the patients at 6 months. Patients who had had symptoms for less than 5 years (p < 0.001), were in an earlier stage of disease (p = 0.006), and who did not have thymomas (p = 0.006) responded better. 3 Patients died of invasive thymoma at 2 1/2, 3, and 5 1/2 years postoperatively and 25/76 (33%) were lost to follow-up. Of the 51 patients available for late follow-up, 19 (37%) were in remission, in 26 (51%) the symptoms had improved, 3 (6%) were unchanged, and 3 (6%) had died of the disease.

Conclusions: Transcervical thymectomy should be considered in patients with early myasthenia gravis.

重症肌无力患者早期胸腺切除术的益处。
目的:报告重症肌无力患者早期胸腺切除术的经验。设计:回顾性研究。单位:希腊大学外科学系。研究对象:重症肌无力患者76例。干预措施:所有病例均行经颈胸腺切除术,4例加行左胸切除术。主要结局指标:死亡率、发病率、胸腺切除术的早期(6个月)和晚期(平均随访4.8年)反应。结果:20例患者发生胸腺瘤(26%)。无术后死亡;发病率为11% (n = 8)。6个月时,19例患者完全缓解(25%),49例患者改善(65%),7例患者无变化(9%),1例患者损害(1%)。出现症状少于5年(p < 0.001)、处于疾病早期阶段(p = 0.006)和没有胸腺瘤(p = 0.006)的患者反应更好。3例患者分别于术后2 1/2、3和5 1/2年死于浸润性胸腺瘤,25/76(33%)失访。在51例晚期随访患者中,19例(37%)缓解,26例(51%)症状改善,3例(6%)无变化,3例(6%)死于疾病。结论:早期重症肌无力患者应考虑经颈胸腺切除术。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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