论文部分内容阅读
目的探讨胸腺扩大切除术治疗重症肌无力(myasthenia gravis,MG)的远期疗效及其影响因素。方法回顾性分析1997年1月-2011年12月确诊为MG并进行胸腺扩大切除+纵隔脂肪清扫手术62例患者的临床资料。术后疗效判断按照美国重症肌无力协会(MGFA)标准:完全缓解、部分缓解(以上2项称为有效)、稳定和恶化。结果总有效率为82.3%,1、3、5年有效率分别为:85.7%、89.4%、76.9%。性别构成、手术时年龄、手术后病理分型、手术前后是否发生危象、肿瘤大小、发病年龄等均与远期疗效无关(P>0.05);术前病程、Osserman分型、术前是否伴有其他疾病、术前服用激素时间与远期疗效有关(P<0.05)。胸腺扩大切除术是治疗MG有效手段;术后随随访时间的延长,缓解率和有效率逐渐提高;非胸腺瘤随随访时间延长比胸腺瘤疗效要好,但非胸腺瘤与胸腺瘤远期疗效之间无统计学差异;结论胸腺扩大切除术是治疗MG的有效手段;手术应综合考虑术前病程、Osserman分型、术前是否伴有其他疾病、术前服用激素时间,以期获得较好的远期疗效。
Objective To investigate the long-term efficacy and influencing factors of myasthenia gravis (MG) undergoing thymus enlargement resection. Methods The clinical data of 62 patients diagnosed with MG with thymus enlargement and mediastinal fat dissection from January 1997 to December 2011 were retrospectively analyzed. According to the American Association for Myasthenia Gravis (MGFA) criteria: complete remission, partial remission (the above two are referred to as effective), stability and deterioration. The total effective rate was 82.3%. The effective rates at 1, 3 and 5 years were 85.7%, 89.4% and 76.9% respectively. Sex composition, age at surgery, postoperative pathological type, whether or not a crisis occurred before and after surgery, tumor size, age of onset, etc. had no correlation with long-term efficacy (P> 0.05); preoperative course, Osserman classification, There are other diseases, preoperative hormone dose and long-term efficacy (P <0.05). Expansion of thymus resection is an effective means of treatment of MG; with the extension of follow-up time, the remission rate and efficiency gradually increased; non-thymoma with the follow-up time is better than the thymoma, but the long-term efficacy of non-thymoma and thymoma There was no statistical difference between the two groups. Conclusions Thymus enlargement resection is an effective method to treat MG. The operation should consider the preoperative course, Osserman classification, whether preoperative with other diseases, preoperative hormone dose, in order to obtain better far Period of efficacy.