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. 胸腔鏡胸腺切除術與傳統手術治療重癥肌無力的長期效果觀察. 中國醫藥指南, 2014, 12(24):91-92.
8.	劉衛彬, 門麗娜, 陳振光, 等. 胸腺擴大切除術治療重癥肌無力遠期療效及影響因素分析. 中華醫學雜志, 2006, 86(45):3182-3185.
9.	陳剛, 陳志明, 龐烈文, 等. 胸腺切除治療重癥肌無力遠期療效及影響因素分析. 復旦學報(醫學版), 2006, 33(6):785-788.
10.	張衛鋒, 伊利亞爾, 李德生, 等. 胸腺擴大切除治療重癥肌無力遠期療效及多因素分析. 新疆醫科大學學報, 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, 李劍鋒, 周足力, 等. 胸腔鏡胸腺擴大切除術治療重癥肌無力的療效觀察及影響因素分析. 中國微創外科雜志, 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.	楊倍, 陳曉峰, 王律, 等. 32例重癥肌無力伴胸腺瘤患者手術治療療效評價. 中國癌癥雜志, 2009, 19(3):221-223.
22.	代秀珍, 曾文慧, 謝頌平. 胸腺切除術治療重癥肌無力43例的手術療效及其影響因素分析. 實用醫院臨床雜志, 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. 胸腔鏡胸腺切除術與傳統手術治療重癥肌無力的長期效果觀察. 中國醫藥指南, 2014, 12(24):91-92.
8. 劉衛彬, 門麗娜, 陳振光, 等. 胸腺擴大切除術治療重癥肌無力遠期療效及影響因素分析. 中華醫學雜志, 2006, 86(45):3182-3185.
9. 陳剛, 陳志明, 龐烈文, 等. 胸腺切除治療重癥肌無力遠期療效及影響因素分析. 復旦學報(醫學版), 2006, 33(6):785-788.
10. 張衛鋒, 伊利亞爾, 李德生, 等. 胸腺擴大切除治療重癥肌無力遠期療效及多因素分析. 新疆醫科大學學報, 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, 李劍鋒, 周足力, 等. 胸腔鏡胸腺擴大切除術治療重癥肌無力的療效觀察及影響因素分析. 中國微創外科雜志, 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. 楊倍, 陳曉峰, 王律, 等. 32例重癥肌無力伴胸腺瘤患者手術治療療效評價. 中國癌癥雜志, 2009, 19(3):221-223.
22. 代秀珍, 曾文慧, 謝頌平. 胸腺切除術治療重癥肌無力43例的手術療效及其影響因素分析. 實用醫院臨床雜志, 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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