Abstract:Objective To explore the related factors of postoperative symptom aggravation in surgical treatment of myasthenia gravis(MG).Methods The clinical data of 128 patients with MG who underwent thymectomy in the Second Affiliated Hospital of Zhengzhou University from June 2013 to June 2019 were retrospectively analyzed.The preoperative and postoperative classifications of each patient were evaluated according to the surgical classification standard of MG,and patients were divided into the addition group and the stable group based on whether they were aggravated.The addition group:after surgery,the symptoms of MG patients were aggravated during the hospitalization(type increased),or the amount of medication requirement was increased.The stable group:after surgery,the symptoms of MG patients were relieved(type reduced)or unchanged(type unchanged)during the hospitalization,or the amount of medication needed to maintain current symptoms was reduced.Single factor and multivariate Logistic regression were used to analyze the related factors of postoperative symptoms aggravated.Results Of the 128 patients,40 cases were in the addition group,and 88 cases were in the stable group.There were statistically significant differences in the surgical methods,Osserman classification and pathological types of thymus between the two groups(P<0.05).Logistic regression analysis showed that surgical methods,Osserman classification,and thymus pathological type were related factors affecting postoperative symptoms of MG patients(P<0.05).In Osserman classification,compared with typeⅠMG patients,patients of typesⅡB andⅢhad a higher probability of postoperative aggravation of symptoms.Conclusion Thymectomy is the main surgical treatment for MG.The choice of surgical methods,Osserman classification and the pathological type of thymoma are related factors for the aggravation of symptoms in MG patients after surgical treatment.Choosing a reasonable surgical method,combined with the MG Osserman classification and the pathological type of the thymus,has guiding significance for the prevention of postoperative symptoms of MG.
Marx A,Willcox N,Leite M,et al.Thymoma and paraneoplastic myasthenia gravis[J].Autoimmunity,2010,43(5-6):413-427.
[3]
Blalock A,Mason MF,Morgan HJ,et al.Myasthenia gravis and tumors of the thymic region:report of a case in which the tumor was removed[J].Ann Surg,1939,110(4):544-561.
[5]
Evoli A,Meacci E.An update on thymectomy in myasthenia gravis[J].Expert Rev Neurother,2019,19(9):823-833.
Bachmann K,Burkhardt D,Schreiter I,et al.Thymectomy is more effective than conservative treatment for myasthenia gravis regarding outcome and clinical improvement[J].Surgery,2009,145(4):392-398.
[6]
Watanabe A,Watanabe T,Obama T,et al.Prognostic factors for myasthenic crisis after transsternal thymectomy in patients with myasthenia gravis[J].J Thorac Cardiovasc Surg,2004,127(3):868-876.
[9]
Wolfe GI,Kaminski HJ,Aban IB,et al.Randomized Trial of Thymectomy in Myasthenia Gravis[J].N Engl J Med,2016,375(6):511-522.
[10]
Leuzzi G,Meacci E,Cusumano G,et al.Thymectomy in myasthenia gravis:proposal for a predictive score of postoperative myasthenic crisis[J].Eur J Cardiothorac Surg,2014,45(4):e76- 88;discussion e88.
[11]
Kato T,Kawaguchi K,Fukui T,et al.Risk Factors for the Exacerbation of Myasthenic Symptoms After Surgical Therapy for Myasthenia Gravis and Thymoma[J].Semin Thorac Cardiovasc Surg,2020,32(2):378-385.
[12]
Li Y,Wang H,Chen P,et al.Clinical outcome and predictive factors of postoperative myasthenic crisis in 173 thymomatous myasthenia gravis patients[J].Int J Neurosci,2018,128(2):103-109.
[13]
Mouri H,Jo T,Matsui H,et al.Effect of Sugammadex on Postoperative Myasthenic Crisis in Myasthenia Gravis Patients:Propensity Score Analysis of a Japanese Nationwide Database[J].Anesth Analg,2020,130(2):367-373.
[14]
Ponseti JM,Gamez J,Vilallonga R,et al.Influence of ectopic thymic tissue on clinical outcome following extended thymectomy in generalized seropositive nonthymomatous myasthenia gravis[J].Eur J Cardiothorac Surg,2008,34(5):1062-1067.
[15]
Gung Y,Zhang H,Li S,et al.Sternotomy versus video-assisted thoracoscopic surgery for thymectomy of myasthenia gravis patients:A meta-analysis[J].Asian J Endosc Surg,2016,9(4):285-294.
[16]
Meyer DM,Herbert MA,Sobhani NC,et al.Comparative clinical outcomes of thymectomy for myasthenia gravis performed by extended transsternal and minimally invasive approaches[J].Ann Thorac Surg,2009,87(2):385- 390;discussion 390-391.
[17]
Lin Q,Zhang Y,Yang L.Single-center retrospective analysis of 162 cases with thymoma complicating myasthenia gravis[J].J BUON,2017,22(3):741-745.
[18]
Chu XY,Xue ZQ,Wang RW,et al.Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy[J].Chin Med J,2011,124(8):1246-1250.
[19]
Xue L,Wang L,Dong J,et al.Risk factors of myasthenic crisis after thymectomy for thymoma patients with myasthenia gravis[J].Eur J Cardiothorac Surg,2017,52(4):692-697.