Analysis Of Clinic Results Of Surgery Treatment For 113 Patients Suffered From Thymoma With MG

Research Background:According to the research,myasthenia gravis is an autoimmune disorder happens to the acetylcholine receptor of postsynaptic membrane.Clinic statistics shows that 65%to 80%of MG patients suffer from disease of thymus of which 10%to 20%is considered to be thymoma.It is assumed from the evidence that thymus gland contribute to the immune response of MG.Since MG associated with thymoma is a combination of two diseases,scholars from home and abroad pay attention to the relationship between them,and study the relevance between prognosis of MG associated with thymoma and the type of MG,WHO Histologic Classifcation Thymoma and Masaoka-Koga Staging System.The type of operation is also an important topic in surgical treatment.Clinical values of Video-Assisted Thoracic surgery(VATs)needs to be confirmed.Obsjective:By collecting clinic data of MG associated with thymoma patients,and setting up database of fellow-up record of patients' short-term effect and long-term survival time,we analyze the clinical character of MG associated with thymoma;explore the effect factors of therapeutic effect and prognosis of MG associated with thymoma;and discuss different clinical values of Video-Assisted Thoracic surgery(VATs)and conventional median sternotomy extended thymectomy.Method:The clinical data of MG associated with thymoma patients treated in the thoracic surgery department of Shandong Provincial Hospital from January 2005 to December 2016 were analyzed retrospectively.Key measurements of statistics are patients' age,gender,type of MG,WHO Histologic Classification and Masaoka-Koga Staging System.The last follow-up was carried out in January,2017.The relevance between different types of MG and staging systems,and treatment effect and survival time is analyzed by independent-sample T test,Chi-square test,Survival Analysis,etc.Surgical time,blood loss,hospitalization time,perioperative complications,closed drainage of pleural cavity,treatment effects and survival rate are compared between VATs and conventional group.Result:1.From January,2005 to December,2016,113 MG associated with thymoma were collected into the database,among which 53.98%with chief complaint of ptosis,35.40%with chief complaint of limbs fatigue,accompanied with/without dyspnea and dysphagia.Average course of disease is 4.62±5.52 months.There is no statistical significance in the length of course between male and female patients(p<0.05).2.Among the 113 cases,the number of male patients is 61 and that of female patients is 52 with a gender proportion of 1.17:1.Patients are between 30 to 60 years old,accounting for 78.65%of whole patients.There was no significant gender difference among different age in 3groups.? and ?A stage account for 70.79%in Masaoka-Koga Staging System;B2 type account for 46.9%in WHO Histologic Classification;and ? and ?A type account for 89.38%in Osserman Clinical Type.After combining all the groups,the effective rates of different types in WHO Histologic Classification are94.29%.86.79%and64%;those for Masaoka-Koga Staging System are92.50%and 63.64%;those for Osserman Clinical Type are 87.13%and 58.33%.There are significant statistical differences in the effective rate and survival time and cumulative survival(p<0.05).4.Compared with conventional group,VATs group has less operation time(161.32±143.61min vs.181.522±44.51min),blood loss during operation(49.12±26.78ml vs.170.51±90.25ml),monitoring time(1.29±0.91 vs 2.67±3.37d),drainage time(3.38±0.985d vs.4.68±1.27d),morbidity of complication during perioperative period(13.33%vs.31.65%)and hospitalization after operation(7.12±1.93d vs.10.11±3.54d).The difference has statistic significance(p<0.05).Besides,there is no significant difference in effective rate(88.24%vs.81.01%),survival time and cumulative survival(p>0.05).Conclusion:1.seniors are age vulnerable to MG associated with thymoma.There is no significant difference of morbidity between male and female patients.Extraocular muscles involvement is the most common symptom and systemic skeletal muscles involvement is the common reasons that urge patients to the hospital.B2 type is the most common type of this diease.Invasive thymoma is relatively rare and has a bad prognosis.Most thymoma has an intact capsule during the operation*Patients with invasive thymoma or metastasis have worse prognosis.2.Efficiency and prognosis could be valued separately by Osserman clinical type of MG,WHO Histologic Classification and Masaoka-Koga Staging System.The later the patient is diagnosed and classified,the worse the prognosis and effect are.3.The clinic effect and survival time of VATs is equal to that of conventional operation.Surgical treatment is proved to be practicable for MG.Thoracic surgery exceeds conventional open surgery in surgical time,blood loss and perioperative management with fewer traumas,faster recovery,fewer complications,and higher satisfaction of patients.