胸腔镜胸腺扩大切除术治疗重症肌无力的临床疗效及影响因素研究

Analysis of the therapeutic efficacy of video-assisted thoracoscopic thymectomy in treatment of myasthenia gravis

摘要:

目的??评估胸腔镜胸腺扩大切除术治疗重症肌无力（MG）的疗效，并分析影响手术疗效的因素。方法?回顾性分析2011年1月-2016年5月该院收治的行胸腔镜胸腺扩大切除术的183例MG患者的临床资料，采用美国重症肌无力联盟（MGFA）标准评价手术疗效。采用单因素分析和Cox比例风险模型分析影响手术疗效的因素。结果?183例患者中，173例患者完成随访，失访10例，随访率94.5%。其中完全稳定缓解（CSR）率为66.5%、药物缓解（PR）率为7.5%、微小症状表现（MM）率为1.2%、改善（I）率为1.2%、无变化（U）率为11.6%、复发（E）率为4.6%、死亡（D）率为1.7%。进一步分析显示年龄（RR=1.53，P =0.031）、病理类型（RR=5.84，P =0.022）、MGFA分型（RR=3.72，P =0.028）是影响手术疗效的因素。结论?胸腔镜扩大切除术治疗MG患者疗效显著，且年龄、病理类型及MGFA分型是影响手术疗效的主要因素。

Abstract:

Objective?To assess the effect of video-assisted thoracoscopic thymectomy in treatment of myasthenia gravis (MG) and the factors associated with clinical efficacy.?Methods?183 patients with MG who underwent video-assisted thoracoscopic thymectomy from January 2011 to May 2016 were enrolled, and the clinical data were retrospectively analyzed. Therapeutic efficacy was evaluated based on the MGFA. Furthermore, the potential factors associated with the clinical efficacy were analyzed using univariate analysis and Cox’s proportional hazards regression model.?Results?173 in 183 patients completed the whole follow-up. Among whom, 115 patients achieved complete stable remission (66.5%), 13 patients achieved pharmacologic remission (7.5%), 2 patients achieved minimal manifestations (1.2%), 20 patients had no changes (11.6%), 8 patients showed recurrent MG (4.6%), and 3 patients died (1.7%). Further analysis shown age (RR = 1.53, P = 0.031), pathological type of thymus (RR = 5.84, P = 0.022) and MGFA classification (RR = 3.72, P = 0.028) were main factors associated with the therapeutic efficacy.?Conclusions?Thoracoscopic expand resection is effective in the treatment of MG patients with satisfactory therapeutic efficacy, and age, pathological type and MGFA type were the main factors associated with the therapeutic efficacy.