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
|
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。
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.
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.
引文
[1]SUNGUR ULKE Z,YAVRU A,CAMCI E,et al.Rocuronium and sugammadex in patients with myasthenia gravis undergoing thymectomy[J].Acta Anaesthesiologica Scandinavica,2013,57(6):745-748.
[2]田辉,沈韦羽,余凯忠,等.全胸腔镜下胸腺扩大切除术治疗重症肌无力的疗效观察[J].现代实用医学,2012,24(11):1230-1231.[2]TIAN H,SHEN W Y,YU K Z,et al.Curative effect of enlarged thymus resection in the treatment of myasthenia gravis under total thoracoscopy[J].Modern Practical Medicine,2012,24(11):1230-1231.Chinese
[3]董晓龙,屈颖聪.电视胸腔镜手术行胸腺扩大切除术治疗重症肌无力的疗效观察[J].医学信息(下旬刊),2013,26(12):299.[3]DONG X L,QU Y C.Clinical efficacy of video-assisted thoracoscopic surgery for enlarged thymus resection in the treatment of myasthenia gravis[J].Medical Information,2013,26(12):299.Chinese
[4]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[J].中国微创外科杂志,2012,12(8):682-686.[4]CUI J,LI J F,ZHOU Z L,et al.Effect of video-assisted thoracoscopic thymectomy for myasthenia gravis and factors infl uencing the outcome[J].Chinese Journal of Minimally Invasive Surgery,2012,12(8):682-686.Chinese
[5]张青平,韩军,何鹏飞.重症肌无力电视胸腔镜与胸骨部分劈开行胸腺扩大切除比较[J].中华胸心血管外科杂志,2010,26(3):187-189.[5]ZHANG Q P,HAN J,HE P F.Comparison study of video assisted thoracoscopic and partial sternotomy extended thymectomy for the myasthenia gravis[J].Chinese Journal of Thoracic and Cardiovascular Surgery,2010,26(3):187-189.Chinese
[6]NG C S,WAN I Y,YIM A P.Video-assisted thoracic surgery thymectomy:the better approach[J].The Annals of Thoracic Surgery,2010,89(6):82135-82141.
[7]景筠,张晓君,于磊,等.眼肌型重症肌无力向全身型转化的预后因素[J].中华神经科杂志,2014,47(1):21-25.[7]JING J,ZHANG X J,YU L,et al.Factors affecting the progression from ocular to generalized myasthenia gravis[J].Chinese Journal of Neurology,2014,47(1):21-25.Chinese
[8]何靖康,宋心雨,黄海涛,等.经左胸电视胸腔镜下全胸腺切除40例临床分析[J].中国胸心血管外科临床杂志,2012,19(2):208-209.[8]HE J K,SONG X Y,HUANG H T,et al.Clinical analysis of total thoracic resection under video-assisted thoracoscopic via left thorax in 40 cases[J].Chinese Journal of Clinical Thoracic and Cardiovascular Surgery,2012,19(2):208-209.Chinese
[9]吴国栋,彭学锋,罗伟彬,等.胸腔镜胸腺扩大切除治疗重症肌无力26例的疗效[J].广东医学,2013,34(5):724-725.[9]WU G D,PENG X F,LUO W B,et al.The effect of extended thymectomy on treatment of myasthenia gravis in 26 cases[J].Guangdong Medical Journal,2013,34(5):724-725.Chinese
[10]刘宏斌,杨光伟,梁庆成.198例胸腺切除的重症肌无力临床分析[J].国际神经病学神经外科学杂志,2005,32(4):301-303.[10]LIU H B,YANG G W,LIANG Q C.Clinical analysis of 198 cases of myasthenia gravis with thymectomy[J].Journal of International Neurology and Neurosurgery,2005,32(4):301-303.Chinese
[11]YOSHIDA S,YOSHINO I,MORIYA Y,et al.Video-assisted thoracoscopic surgery extended thymectomy for myasthenia gravis using manual manipulators:the radius surgical system[J].Annals of Thoracic Surgery,2011,92(6):2246-2248.
[12]LIN M W,CHANG Y L,HUANG P M.Thymectomy for nonthymomatous myasthenia gravis:a comparison of surgical methods and analysis of prognostic factors[J].European Journal of Cardio-Thoracic Surgery,2010,37(1):7-12.
[13]KIRSCHNER P A.Alfred Blalock and thymectomy for myasthenia gravis[J].Annals of Thoracic Surgery,1987,43(3):348-349.
[14]OKUMURA M,FUJII Y,SHIONO H,et al.Immunological function of thymoma and pathogenesis of paraneoplastic myasthenia gravis[J].General Thoracic and Cardiovascular Surgery,2008,56(4):143-150.
[15]SOLTYS J,GONG B,KAMINSKI H J,et al.Extraocular muscle susceptibility to myasthenia gravis[J].Annals of the New York Academy of Sciences,2008,1132:220-224.
[16]YIM A P,IZZAT M B,LEE T W,et al.Video-assisted thoracoscopic thymectomy[J].Annals of Thoracic&Cardiovascular Surgery,1999,5(1):18-20.
[17]CUSUMANO G,CESARIO A,MARGARITORA S.Open versus thoracoscopic thymectomy for non-neoplastic myasthenic patients:is there a space for a third way[J].European Journal of Cardio-Thoracic Surgery,2010,37(3):746.
[18]杨惠,金永华,张莹.T细胞免疫在胸腺瘤与重症肌无力发病中的研究进展[J].卒中与神经疾病,2013,20(1):62-63.[18]YANG H,JIN Y H,ZHANG Y.Progress in study of the role of Tcell immunity in the pathogenesis of thymoma and myasthenia gravis[J].Stroke and Nervous Diseases,2013,20(1):62-63.Chinese
[19]于涛,马山,李建业,等.胸腔镜下胸腺扩大切除术治疗眼肌型重症肌无力[J].医学临床研究,2012,29(12):2286-2288.[19]YU T,MA S,LI J Y,et al.Video-assisted thoracoscopic extended thymectomy for the treatment of ocular myasthenia gravis[J].Journal of Clinical Research,2012,29(12):2286-2288.Chinese
[2]田辉,沈韦羽,余凯忠,等.全胸腔镜下胸腺扩大切除术治疗重症肌无力的疗效观察[J].现代实用医学,2012,24(11):1230-1231.[2]TIAN H,SHEN W Y,YU K Z,et al.Curative effect of enlarged thymus resection in the treatment of myasthenia gravis under total thoracoscopy[J].Modern Practical Medicine,2012,24(11):1230-1231.Chinese
[3]董晓龙,屈颖聪.电视胸腔镜手术行胸腺扩大切除术治疗重症肌无力的疗效观察[J].医学信息(下旬刊),2013,26(12):299.[3]DONG X L,QU Y C.Clinical efficacy of video-assisted thoracoscopic surgery for enlarged thymus resection in the treatment of myasthenia gravis[J].Medical Information,2013,26(12):299.Chinese
[4]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[J].中国微创外科杂志,2012,12(8):682-686.[4]CUI J,LI J F,ZHOU Z L,et al.Effect of video-assisted thoracoscopic thymectomy for myasthenia gravis and factors infl uencing the outcome[J].Chinese Journal of Minimally Invasive Surgery,2012,12(8):682-686.Chinese
[5]张青平,韩军,何鹏飞.重症肌无力电视胸腔镜与胸骨部分劈开行胸腺扩大切除比较[J].中华胸心血管外科杂志,2010,26(3):187-189.[5]ZHANG Q P,HAN J,HE P F.Comparison study of video assisted thoracoscopic and partial sternotomy extended thymectomy for the myasthenia gravis[J].Chinese Journal of Thoracic and Cardiovascular Surgery,2010,26(3):187-189.Chinese
[6]NG C S,WAN I Y,YIM A P.Video-assisted thoracic surgery thymectomy:the better approach[J].The Annals of Thoracic Surgery,2010,89(6):82135-82141.
[7]景筠,张晓君,于磊,等.眼肌型重症肌无力向全身型转化的预后因素[J].中华神经科杂志,2014,47(1):21-25.[7]JING J,ZHANG X J,YU L,et al.Factors affecting the progression from ocular to generalized myasthenia gravis[J].Chinese Journal of Neurology,2014,47(1):21-25.Chinese
[8]何靖康,宋心雨,黄海涛,等.经左胸电视胸腔镜下全胸腺切除40例临床分析[J].中国胸心血管外科临床杂志,2012,19(2):208-209.[8]HE J K,SONG X Y,HUANG H T,et al.Clinical analysis of total thoracic resection under video-assisted thoracoscopic via left thorax in 40 cases[J].Chinese Journal of Clinical Thoracic and Cardiovascular Surgery,2012,19(2):208-209.Chinese
[9]吴国栋,彭学锋,罗伟彬,等.胸腔镜胸腺扩大切除治疗重症肌无力26例的疗效[J].广东医学,2013,34(5):724-725.[9]WU G D,PENG X F,LUO W B,et al.The effect of extended thymectomy on treatment of myasthenia gravis in 26 cases[J].Guangdong Medical Journal,2013,34(5):724-725.Chinese
[10]刘宏斌,杨光伟,梁庆成.198例胸腺切除的重症肌无力临床分析[J].国际神经病学神经外科学杂志,2005,32(4):301-303.[10]LIU H B,YANG G W,LIANG Q C.Clinical analysis of 198 cases of myasthenia gravis with thymectomy[J].Journal of International Neurology and Neurosurgery,2005,32(4):301-303.Chinese
[11]YOSHIDA S,YOSHINO I,MORIYA Y,et al.Video-assisted thoracoscopic surgery extended thymectomy for myasthenia gravis using manual manipulators:the radius surgical system[J].Annals of Thoracic Surgery,2011,92(6):2246-2248.
[12]LIN M W,CHANG Y L,HUANG P M.Thymectomy for nonthymomatous myasthenia gravis:a comparison of surgical methods and analysis of prognostic factors[J].European Journal of Cardio-Thoracic Surgery,2010,37(1):7-12.
[13]KIRSCHNER P A.Alfred Blalock and thymectomy for myasthenia gravis[J].Annals of Thoracic Surgery,1987,43(3):348-349.
[14]OKUMURA M,FUJII Y,SHIONO H,et al.Immunological function of thymoma and pathogenesis of paraneoplastic myasthenia gravis[J].General Thoracic and Cardiovascular Surgery,2008,56(4):143-150.
[15]SOLTYS J,GONG B,KAMINSKI H J,et al.Extraocular muscle susceptibility to myasthenia gravis[J].Annals of the New York Academy of Sciences,2008,1132:220-224.
[16]YIM A P,IZZAT M B,LEE T W,et al.Video-assisted thoracoscopic thymectomy[J].Annals of Thoracic&Cardiovascular Surgery,1999,5(1):18-20.
[17]CUSUMANO G,CESARIO A,MARGARITORA S.Open versus thoracoscopic thymectomy for non-neoplastic myasthenic patients:is there a space for a third way[J].European Journal of Cardio-Thoracic Surgery,2010,37(3):746.
[18]杨惠,金永华,张莹.T细胞免疫在胸腺瘤与重症肌无力发病中的研究进展[J].卒中与神经疾病,2013,20(1):62-63.[18]YANG H,JIN Y H,ZHANG Y.Progress in study of the role of Tcell immunity in the pathogenesis of thymoma and myasthenia gravis[J].Stroke and Nervous Diseases,2013,20(1):62-63.Chinese
[19]于涛,马山,李建业,等.胸腔镜下胸腺扩大切除术治疗眼肌型重症肌无力[J].医学临床研究,2012,29(12):2286-2288.[19]YU T,MA S,LI J Y,et al.Video-assisted thoracoscopic extended thymectomy for the treatment of ocular myasthenia gravis[J].Journal of Clinical Research,2012,29(12):2286-2288.Chinese