胸腺切除加前纵隔脂肪清扫治疗重症肌无力的预后分析
Prognostic analysis of patients with myasthenia gravis after extended thymectomy
目的 探讨胸腺切除+前纵隔脂肪清扫治疗重症肌无力的远期疗效并分析预后相关因素.方法 回顾性分析2006年1月至2015年10月在安徽医科大学附属省立医院胸外科接受胸腺切除+前纵隔脂肪清扫术的72例重症肌无力患者的临床资料.男性32例,女性40例;手术时年龄10.70岁,平均39.5岁.采用x2检验对性别、手术时年龄、术前病程、术前是否服用激素、改良Osserman分型、胸腺病理等可能影响预后的因素进行单因素分析,并用Logistic回归进行多因素分析.结果 72例患者随访6.75个月,中位随访时间37个月,21例(29.2%)完全稳定缓解,18例(25.0%)药物缓解,20例(27.8%)改善,9例(12.5%)无变化,4例(5.6%)恶化.单因素及多因素分析结果显示,术前病程(OR=22.871,95% CI:2.813.~ 185.917,P=0.003)、Osserman分型(OR=0.103,95% CI:0.014.0.774,P=0.027)是术后有效的独立预后因素.结论 胸腺切除+前纵隔脂肪清扫治疗重症肌无力远期疗效好.术前病程、Osserman分型是术后有效的独立预后因素,术前病程<6个月、全身型患者的预后较好.
更多Objective To identify the long-term outcome of patients with myasthenia gravis (MG) after extended thymectomy,and to analyze the prognostic factors.Methods The medical data and follow-up results in 72 patients with MG who underwent extended thymectomy in Department of Thoracic Surgery,Anhui Provincial Hospital Affiliated with Anhui Medical University from January 2006 to October 2015 were retrospectively reviewed and analyzed.There were 32 male and 40 female patients,aging from 10 to 70 years with a mean age of 39.5 years.The outcome-related factors including gender,age while being operated on,duration of preoperative period,whether taking steroid before operation,modified Osserman classification,pathology type of thymus were analyzed by x2 test and multivariate regression analysis.Results All patients were followed up from 6 to 75 months (median 37 months).Among them,21 patients (29.2%) achieved complete stable remission,18 patients (25.0%) experienced pharmcological remission,20 patients (27.8%) improved,9 patients (12.5%) reminded stable and 4 patieuts (5.6%) deteriorated.Both univariate and muhicariate analysis revealed that duration of preoperative period (OR =22.871,95% CI:2.813 to 185.917,P=0.003) and Osserman classification (OR=0.103,95% CI:0.014 to 0.774,P=0.027) showed significantly associated with the surgical curative effect.Conclusions Extended thymectomy is an efective measure for MG.The duration of preoperative period and Osserman classification are prognostic factors for thymectomized MG.Those patients with generalized MG or whose duration of preperative period is less than 6 months are likely to have better prognosis.
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