单纯重症肌无力外科治疗远期疗效分析

Long-term outcome of surgical treatment for nonthymomatous myasthenia gravis

目的 探讨手术切除胸腺治疗单纯重症肌无力(MG)的预后及其影响因素。方法 回顾分析我院1978-2 0 0 4年手术治疗的2 16例单纯MG患者临床资料、随访结果,探讨性别、年龄、术前Osserman分型、术前病程、病理类型等因素对手术疗效的影响。结果 单纯MG患者手术后的缓解率随着时间的延长而提高,术后1、3、5年完全缓解率分别为2 1 2 %、43 0 %、43 4% ,有效率为87 6%、91 9%、92 1%。术前病程在1年以内者术后1、3、5年有效率为92 1%、95 4%、96 4% ,在1年以上者为81 2 %、85 4%、81 0 % ,统计学分析两者有显著性差异。性别、年龄、术前Osserman分型、病理变化对手术疗效无明显影响。结论 胸腺切除术是治疗MG的有效手段,病程短的患者手术疗效优于病程长的患者。

Objective To study the significance of thymectomy as a therapeutic method to treat patients with nonthymomatous myasthenia gravis (NTMG). Methods Two hundred and sixteen cases of NTMG undergoing thymectomy between 1978 and 2004 were included. The course of follow-up was at least one year. For all cases, gender, age, Osserman classification of the symptom, illness duration prior to operation and pathological types of the resected thymus, as well as the results of follow-up were retrospectively analyzed. Effective rate and remission rate were both calculated at time points of 1, 3 and 5 year after operation. Results Effective and remission rates of NTMG both improved in the follow-up period. Complete remission rate (CR) was 21.2%, 43.0% and 43.4% respectively during the follow-up at the year of 1, 3 and 5, and effective rate was 87.6%, 91.9% and 92.1% respectively. For a subclass of cases, whose illness duration was within one year prior to operation, the effective rate was 92.1%, 95.4% and 96.4% respectively, while the effective rate significantly was 81.2%, 85.4%, and 81.0% in the remainders whose illness duration was more than one year prior to operation. Conclusion Thymectomy is an effective therapy for the patients with NTMG and shows a better prognosis in the patients with a shorter illness duration.