Operative treatment of myasthenia gravis.
Although the relationship between the thymus gland and myasthenia gravis is still not clear, it has been recognized for many years that, however, early thymectomy can bring about remission or improvement of the disease. In the past 12 years, 40 myasthenic patients have received total thymectomies in the Department of Surgery, Kaohsiung Medical College Hospital. Their ages ranged from 13 to 68 years. They were classified according to Osserman's classification. After an average follow up period of 4 years, the total remission rate was 32.5%, and the improvement rate was 27.5%. The average interval between thymectomy and onset of remission was 12 months. The operative mortality was 5% and overall mortality 10%. Patients who received thymectomies under 40 years of age, short duration between disease onset and the thymectomy, milder preoperative symptoms and nontumorous thymuses, seemed to have better prognoses. Early thymectomy in childhood myasthenia gravis is still controversial. Although generally the ocular type was treated in a conservative manner, we had a 40% rate of surgical remission in this group. Total longitudinal median sternotomy is our choice of approach because the operative field is larger and the thymectomy is more complete. Thymectomy in immune diseases other than myasthenia gravis is one of our important points for future studies.
Chou
S H
SH
Department of Surgery, Kaohsiung Medical College, Taiwan, Republic of China.
Kao
E L
EL
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D011379:Prognosis; D012074:Remission Induction; D013934:Thymectomy / Q000379:methods; D016896:Treatment Outcome