Long-term Effectiveness of Extended Tymectomy in the Treatment of Myasthenia Gravis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANGXian-liang , XUMei-qing ,  MADong-chun , WEIDa-zhong

Department of Toracic Surgery, Anhui Provincial Hospital, Hefei 230001, P. R. China;

Corresponding author：

MADong-chun, Email: madongchun126@126.com

Keywords：

Thymectomy; Myasthenia gravis; Long-term effectiveness

DOI：

10.7507/1007-4848.20150278

Video：

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Objective To assess the long-term efficacy of extended thymectomy in the treatment of myasthenia gravis(MG) and the factors influencing the results. Methods We retrospectively analyzed the clinical data of 45 MG patients who underwent extended thymectomy in our hospital from January 2005 through December 2010. There were 11males and 34 females at age of 32.6(16-50) years. The overall effective rate was calculated. Univariate analysis was used to analyze the risk factors including sex, age, Osserman classification, and pathological type for outcomes. Results All the patients were followed up for a mean of 58.3 months(ranged from 36 to 108 months). The overall effective rate was 80.0%(36/45) and rose with the extention of time. Age(P=0.019), pathological type(P=0.024) of thymus and Osserman classification(P=0.043) of MG were the main factors influencing the outcomes of the treatment except sex(P=0.666). Conclusion Extended thymectomy in the treatment of MG has better outcomes. And the overall effective rate rises with the extention of time.

Citation： JIANGXian-liang, XUMei-qing, MADong-chun, WEIDa-zhong. Long-term Effectiveness of Extended Tymectomy in the Treatment of Myasthenia Gravis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(12): 1114-1116. doi: 10.7507/1007-4848.20150278 Copy

1.	Barnett C, Katzberg HD, Keshavjee S, et al. Thymectomy for non-thymomatous myasthenia gravis:a propensity score matched study. Orphanet J Rare Dis, 2014, 9(1):214-222.
2.	Kumar N, Verma AK, Mishra A, et al. Factors predicting surgical outcome of thymectomyin myastheniagravis:A 16-year experience. Ann Indian Acad Neurol, 2011, 14(4):267-271.
3.	Mineo TC, Ambroqi V. Outcomes after thymectomy in class I myastheniagravis. J Thorac Cardiovasc Surg, 2013, 11(5):257-562.
4.	Tommaso CM, Vincenzo A. Outcomes after thymectomy in class I myasthenia gravis. J Thorac Cardiovasc Surg, 2013, 1(1):1-6.
5.	Gronseth GS, Barohn RJ. Practice parameter:thymectomy for autoimmune myasthenia gravis (an evidence-based review):report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2000, 55(1):7-15.
6.	Diaz A, Black E, Dunning J. Is thymectomyin non-thymomatous myastheniagravis of any benefit? Interact Cardiovasc Thorac Surg, 2014, 18(3):381-389.
7.	曾格林. 胸腔镜胸腺切除术与传统手术治疗重症肌无力的长期效果观察. 中国医药指南, 2014, 12(24):91-92.
8.	刘卫彬, 门丽娜, 陈振光, 等. 胸腺扩大切除术治疗重症肌无力远期疗效及影响因素分析. 中华医学杂志, 2006, 86(45):3182-3185.
9.	陈刚, 陈志明, 庞烈文, 等. 胸腺切除治疗重症肌无力远期疗效及影响因素分析. 复旦学报(医学版), 2006, 33(6):785-788.
10.	张卫锋, 伊利亚尔, 李德生, 等. 胸腺扩大切除治疗重症肌无力远期疗效及多因素分析. 新疆医科大学学报, 2013, 36(2):208-211.
11.	DeFilippi VJ, Richman DP, Ferguson MK. Transcervical thymectomy for myasthenia gravis. Ann Thorac Surg, 1994, 57(1):194-197.
12.	Blalock A, Mason MF, Morgan HJ, et al. Myasthenia gravis and tumors of the thymic region. Ann Surg, 1939, 110(4):544-561.
13.	Gripp S, Hulgers K, Wurm R, et al. Thymoma:prognostic factors and treatment outcomes. Cancer, 1998, 83(8):1495.
14.	Masaoka A, Nagaoka Y, Kotake Y. Distribution of thymic tissue at the anterior mediastinum-current procedures in thymectomy. J Thorac Cardiovasc Surg, 1975, 70(11):747-754.
15.	Liu CW, Luo M, Mei JD, et al. Perioperative and long-term outcome of thymectomy for myasthenia gravis:comparison of surgical approaches and prognostic analysis. Chin Med J, 2013, 126(1):34-40.
16.	Shrager JB, Nathan D, Brinster CJ, et al. Outcomes after 151 extended transcervical thymectomies for myasthenia gravis. Ann Thorac Surg, 2006, 82(6):1863-1869.
17.	崔健, 李剑锋, 周足力, 等. 胸腔镜胸腺扩大切除术治疗重症肌无力的疗效观察及影响因素分析. 中国微创外科杂志, 2012, 12(8):682-686.
18.	Ozdemir N, Kara M, Dikmen E, et al. Predictor of clinical outcome following extended thymectomy in myasthenia gravis. Eur J Cardiothorac Surg, 2003, 23(9):233-237.
19.	Stern LE, Nussbaum MS, Quinlan JG, et al. Longterm evaluation of extended thymectomy with anterior mediastinal dissection for myasthenia gravis. Surgery, 2001, 130(3):774-779.
20.	Tumulescu V, Ion V, Kosa A, et al. Thoracoscopic thymectomy mid-term results. Ann Thorac Surg, 2006, 82(8):1003-1008.
21.	杨倍, 陈晓峰, 王律, 等. 32例重症肌无力伴胸腺瘤患者手术治疗疗效评价. 中国癌症杂志, 2009, 19(3):221-223.
22.	代秀珍, 曾文慧, 谢颂平. 胸腺切除术治疗重症肌无力43例的手术疗效及其影响因素分析. 实用医院临床杂志, 2012, 9(2): 61-63.

1. Barnett C, Katzberg HD, Keshavjee S, et al. Thymectomy for non-thymomatous myasthenia gravis:a propensity score matched study. Orphanet J Rare Dis, 2014, 9(1):214-222.
2. Kumar N, Verma AK, Mishra A, et al. Factors predicting surgical outcome of thymectomyin myastheniagravis:A 16-year experience. Ann Indian Acad Neurol, 2011, 14(4):267-271.
3. Mineo TC, Ambroqi V. Outcomes after thymectomy in class I myastheniagravis. J Thorac Cardiovasc Surg, 2013, 11(5):257-562.
4. Tommaso CM, Vincenzo A. Outcomes after thymectomy in class I myasthenia gravis. J Thorac Cardiovasc Surg, 2013, 1(1):1-6.
5. Gronseth GS, Barohn RJ. Practice parameter:thymectomy for autoimmune myasthenia gravis (an evidence-based review):report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 2000, 55(1):7-15.
6. Diaz A, Black E, Dunning J. Is thymectomyin non-thymomatous myastheniagravis of any benefit? Interact Cardiovasc Thorac Surg, 2014, 18(3):381-389.
7. 曾格林. 胸腔镜胸腺切除术与传统手术治疗重症肌无力的长期效果观察. 中国医药指南, 2014, 12(24):91-92.
8. 刘卫彬, 门丽娜, 陈振光, 等. 胸腺扩大切除术治疗重症肌无力远期疗效及影响因素分析. 中华医学杂志, 2006, 86(45):3182-3185.
9. 陈刚, 陈志明, 庞烈文, 等. 胸腺切除治疗重症肌无力远期疗效及影响因素分析. 复旦学报(医学版), 2006, 33(6):785-788.
10. 张卫锋, 伊利亚尔, 李德生, 等. 胸腺扩大切除治疗重症肌无力远期疗效及多因素分析. 新疆医科大学学报, 2013, 36(2):208-211.
11. DeFilippi VJ, Richman DP, Ferguson MK. Transcervical thymectomy for myasthenia gravis. Ann Thorac Surg, 1994, 57(1):194-197.
12. Blalock A, Mason MF, Morgan HJ, et al. Myasthenia gravis and tumors of the thymic region. Ann Surg, 1939, 110(4):544-561.
13. Gripp S, Hulgers K, Wurm R, et al. Thymoma:prognostic factors and treatment outcomes. Cancer, 1998, 83(8):1495.
14. Masaoka A, Nagaoka Y, Kotake Y. Distribution of thymic tissue at the anterior mediastinum-current procedures in thymectomy. J Thorac Cardiovasc Surg, 1975, 70(11):747-754.
15. Liu CW, Luo M, Mei JD, et al. Perioperative and long-term outcome of thymectomy for myasthenia gravis:comparison of surgical approaches and prognostic analysis. Chin Med J, 2013, 126(1):34-40.
16. Shrager JB, Nathan D, Brinster CJ, et al. Outcomes after 151 extended transcervical thymectomies for myasthenia gravis. Ann Thorac Surg, 2006, 82(6):1863-1869.
17. 崔健, 李剑锋, 周足力, 等. 胸腔镜胸腺扩大切除术治疗重症肌无力的疗效观察及影响因素分析. 中国微创外科杂志, 2012, 12(8):682-686.
18. Ozdemir N, Kara M, Dikmen E, et al. Predictor of clinical outcome following extended thymectomy in myasthenia gravis. Eur J Cardiothorac Surg, 2003, 23(9):233-237.
19. Stern LE, Nussbaum MS, Quinlan JG, et al. Longterm evaluation of extended thymectomy with anterior mediastinal dissection for myasthenia gravis. Surgery, 2001, 130(3):774-779.
20. Tumulescu V, Ion V, Kosa A, et al. Thoracoscopic thymectomy mid-term results. Ann Thorac Surg, 2006, 82(8):1003-1008.
21. 杨倍, 陈晓峰, 王律, 等. 32例重症肌无力伴胸腺瘤患者手术治疗疗效评价. 中国癌症杂志, 2009, 19(3):221-223.
22. 代秀珍, 曾文慧, 谢颂平. 胸腺切除术治疗重症肌无力43例的手术疗效及其影响因素分析. 实用医院临床杂志, 2012, 9(2): 61-63.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Long-term Effectiveness of Extended Tymectomy in the Treatment of Myasthenia Gravis

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