手术对胸腺瘤合并重症肌无力的疗效

Analysis of the efficacy on myasthenia gravis after thymoma resection and the prognostic factors

目的探讨胸腺瘤合并重症肌无力患者行胸腺瘤切除术后对重症肌无力的疗效,分析影响重症肌无力预后的因素。方法选取2013年1月至2016年12月接受胸腺瘤切除术的胸腺瘤合并重症肌无力患者55例,术后观察患者短期疗效(3个月)与远期疗效(1、3、5年),评估患者术后的短期疗效与远期疗效,根据效果将患者分为有效组与无效组,分析年龄、性别、患病时长、重症肌无力Osserman分型、WHO胸腺瘤分型、胸腺瘤Masaoka分期、手术方式等因素对效果的影响。结果术后3个月,重症肌无力患者短期治疗有效率为60.0%;术后1年,患者治疗有效率为74.5%;术后3年,患者治疗有效率为81.8%;术后5年,患者治疗有效率为89.1%;患者术后5年有效率远高于术后3个月(P<0.05);术后3个月,与治疗效果相关的影响因素有患者年龄、重症肌无力Osserman分型(P<0.05),术后1年,与治疗效果相关的影响因素有年龄、重症肌无力Osserman分型(P<0.05),术后3年,患者年龄、性别、患病时长、胸腺肿瘤Masaoka分期、重症肌无力Osserman分型均对患者治疗效果无影响(P>0.05),术后5年,与患者治疗效果相关的影响因素有患者患病时长(P<0.05)。结论胸腺瘤术后对重症肌无力的疗效随术后时间推移逐渐增强,胸腺瘤合并重症肌无力患者尽早进行手术可有效改善重症肌无力的预后。

Objective To investigate the therapeutic effect of thymectomy on patients with thymomas complicated with myasthenia gravis,and to analyze the prognostic factors.Methods A total of 55 patients with thymomas complicated with myasthenia gravis who were treated with thymoma resection from January 2013 to December 2016 were recruited.The short-term(3 months)and long-term efficacy(1,3 and 5 years)were assessed.Patients were divided into effective group and ineffective group based on the postoperative outcome.The influences of age,sex,disease course,Osserman’s Classification,the World Health Organization(WHO)classification,Masaoka staging system of thymoma,as well as surgical procedures on the prognosis of these patients were assessed.Results The effective rate at 3 months,1 year,3 years and 5 years of these patients was 60.0%,74.5%,81.8%and 89.1%,respectively.The effective rate was significantly enhanced in the fifth year than in the third month time(P<0.05).The age and Osserman’s Classification significantly influenced the treatment outcome at 3 months and 1 year postoperatively(both P<0.05).At 3 years postoperatively,neither the age,sex,disease course,Masaoka staging system of thymoma nor the Osserman’s Classification influenced the treatment outcome(P>0.05).At 5 years postoperatively,disease course significantly influenced the treatment outcome(P<0.05).Conclusion The efficacy on patients with thymomas complicated with myasthenia gravis who are treated with thymoma resection gradually increases over time.An early surgery is believed to effectively improve the prognosis of these patients.