胸腺瘤合并重症肌无力患者术后远期疗效及影响因素分析

Long-term Efficacy and Influencing Factors of Thymectomy for Thymoma Patients Associated with Myasthenia Gravis

目的 探讨胸腺瘤合并重症肌无力（myasthenia gravis,MG）患者术后的远期疗效及其影响因素。方法 回顾性分析2002年6月至2014年12月在我院行胸腺扩大切除术的63例胸腺瘤合并重症肌无力的患者的临床资料及随访结果,其中男26例、女37例,平均年龄（54.51±12.62）岁。运用生存分析模型对性别、手术时年龄、术前病程、伴有其他疾病、危象史、术前激素服用时间、Osserman分型、Masaoka分期、WHO病理分型、手术路径、肿瘤大小等因素对术后疗效的影响进行统计学分析。结果 平均随访时间35（5～96）个月。随访期间,12例（19%）患者完全缓解,39例（62%）部分缓解,7例（11%）病情稳定,5例（8%）加重,总有效率为81%。Log-rank分析显示术前病程（P=0.027）、肌无力危象史（P=0.035）和Osserman分型（P=0.018）与术后MG未完全缓解有关,Cox回归分析显示术前病程（P=0.001）、Osserman分型（P=0.012）是术后重症肌无力未完全缓解的独立危险因素。结论 胸腺扩大根治术是治疗胸腺瘤合并重症肌无力的有效方式,但术前病程≥12个月和Osserman分型ⅡB、Ⅲ和Ⅳ型的胸腺瘤合并重症肌无力患者术后肌无力症状不易完全缓解。

Objective To investigate the long-term efficacy and the influencing factors of thymectomy for thymoma patients associated with myasthenia gravis. Methods We retrospectively analyzed the clinical and followup data of 126 thymoma patients associated with myasthenia gravis underwent extended thymectomy from June 2002 to December 2015 in our hospital. There were 26 males and 37 females at the mean age of 54.51±12.62 years. We built up survival analysis model to analyze the effect of those following factors on postoperative result： sex, the age when operated, the preoperative course of disease, the condition of associating with other diseases, history of critical illness, steroid administration time before operation, Osserman classification, Masaoka staging, WHO pathological type, surgical approach, tumor size and so on. Result The average follow-up time was 35（5-96） months. During follow-up period, 12 patients（19%） achieved complete remission, 39 patients（62%） achieved partial remission, 7 patients（11%） kept stable, 5 patients（8%） deteriorated and the total effective rate was 81%. The result of log-rank analysis showed that the preoperative course of disease（P=0.027）, history of critical illness on myasthenia gravis（P=0.035） and Osserman classification（P=0.018） were related to incomplete remission, whlie the result of Cox regression analysis showed that the preoperative course of disease（P=0.001） and Osserman classification（P=0.012） were the independent risk factors for incomplete remission. Conclusion Extended thymectomy is an effective treatment for thymoma patients associated with myasthenia gravis, but the symptom of those patients whose preoperative course of disease are more than 12 months or Osserman classification is at ⅡB, Ⅲ and Ⅳ type of Osserman classification have poor effect after operation.