CAJ | 학술논문

目的评价胸腔镜下胸腺扩大切除治疗非胸腺瘤重症肌无力的中远期治疗效果并分析影响因素.方法回顾112例胸腔镜下胸腺扩大切除术治疗非胸腺瘤重症肌无力患者的临床资料,其中男47例,女65例;年龄18～70岁,平均40.9岁.应用美国重症肌无力协会制定的治疗后状况分类评价术后治疗效果,采用Kaplan-Meier法及Cox回归模型分析各种可能的影响因素.结果随访1.5～6.2年,平均3.2年,无失访.无加重及死亡病例,其中完全稳定缓解54例(48.2％),药物缓解21例(18.8％),微小症状表现10例(8.9％),改善7例(6.3％),无变化20例(17.8％).多因素分析显示:年龄(P＜0.01,OR=3.468)、术前病程(P＜0.01,OR=3.203)、术后病理(P＜0.01,OR=3.064)是非胸腺瘤重症肌无力患者术后治疗效果的独立影响因素.结论胸腔镜下胸腺扩大切除治疗非胸腺瘤重症肌无力治疗效果满意,年龄、术前病程及胸腺病理类型影响手术治疗效果.
목적 평개흉강경하흉선확대절제치료비흉선류중증기무력적중원기치료효과병분석영향인소.방법 회고112례흉강경하흉선확대절제술치료비흉선류중증기무력환자적림상자료,기중남47례,녀65례;년령18～70세,평균40.9세.응용미국중증기무력협회제정적치료후상황분류평개술후치료효과,채용Kaplan-Meier법급Cox회귀모형분석각충가능적영향인소.결과 수방1.5～6.2년,평균3.2년,무실방.무가중급사망병례,기중완전은정완해54례(48.2％),약물완해21례(18.8％),미소증상표현10례(8.9％),개선7례(6.3％),무변화20례(17.8％).다인소분석현시:년령(P＜0.01,OR=3.468)、술전병정(P＜0.01,OR=3.203)、술후병리(P＜0.01,OR=3.064)시비흉선류중증기무력환자술후치료효과적독립영향인소.결론 흉강경하흉선확대절제치료비흉선류중증기무력치료효과만의,년령、술전병정급흉선병리류형영향수술치료효과.
Objective The aims of this study were to assess the efficacy of video-assisted thoracoscopic extended thymectomy(VATET) as a treatment for non-thymomatous myasthenia gravis (NTMG) and to identify prognostic factors for thymectomy.Methods Retrospectively analyzed clinical datas of 112 patients received VATET for the treatment of NTMG.Clinical efficacy and variables influencing outcome were evaluated by Kaplan-Meier method and Cox proportional hazards regression analysis.Results At 3.2 years averaged (1.5-6.2 years) of follow-up,none of these patients were lost to follow up.According to the MGFA post-intervention status,54 patients(48.2％) obtained complete stable remission during follow-up,21 patients(18.8％) obtained pharmacologic remission,10 patients (8.9％) obtained minimal manifestations,7 patients (6.3％) improved,20 patients(17.8％) unchanged,and none of these patients were worse or died of MG.By multivariate analysis,the chance of complete stable remission was significantly increased when age ＜ 40 years (P ＜ 0.01,OR =3.468),symptom duration ＜ 12 months(P ＜ 0.01,OR =3.203) and the presence of thymic hyperplasia (P ＜ 0.01,OR =3.064).Conclusion Video-assisted thoracoscopic extended thymectomy achieved satisfactory long-term results in patients with nonthymomatous myasthenia gravis,while age,symptom duration,the presence of thymic hyperplasia correlated with response to operation.