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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 influencing factors of postoperative thymoma combined with myasthenia gravis (MG). Methods The clinical data and follow-up results of 63 patients with thymoma combined with myasthenia gravis undergoing thymectomy in our hospital from June 2002 to December 2014 were retrospectively analyzed. There were 26 males and 37 females with mean age (54.51 ± 12.62) years old. Survival analysis model was used to analyze the effects of gender, age at surgery, preoperative course of disease, other diseases associated with, crisis history, preoperative hormone administration time, Osserman classification, Masaoka staging, WHO pathological classification, surgical path, tumor size and other factors Postoperative effects of statistical analysis. Results The average follow-up time was 35 (5-96) months. During follow-up, complete remission was achieved in 12 patients (19%), partial remission in 39 patients (62%), stabilization in 7 patients (11%), and worsening in 5 patients (8%). Log-rank analysis showed that the preoperative course (P = 0.027), the history of myasthenic crisis (P = 0.035) and the Osserman classification (P = 0.018) were related to the incomplete remission of MG. Cox regression analysis showed that preoperative course P = 0.001). Osserman classification (P = 0.012) was an independent risk factor for incomplete remission of postoperative myasthenia gravis. Conclusions Thymus enlargement is an effective way to treat thymoma combined with myasthenia gravis. However, the patients with thymoma with myasthenia gravis Ⅱ B, Ⅲ and Ⅳ with less than 12 months preoperative course and Osserman classification are not easy to complete ease.