title: Evaluation of the new classification and surgical strategy for myasthenia gravis.
abstract: The aim of this study was to discuss the new methods of clinical classification and staging of patients with myasthenia gravis (MG) proposed by our group and to summarize the experiences of surgical treatment of MG with a novel incision by cutting the sternum cross-sectionally at the  second intercostal level. A retrospective analysis was made for the clinical data from the patients with MG who underwent thymectomy from July 1988 to May 2009. The surgical procedures were designed into three groups, a group with Osserman classification and median incision of the sternum  (Group 1), a group with MGFA typing (Myasthenia Gravis Foundation of America) and a small transverse sternal incision at the second intercostal level (Group 2), and a group with new typing and a smaller transverse sternal incision at the second intercostal level (Group 3). Observation of the  clinical typing and staging was made in the patients with myasthenia crisis. The parameters such as procedure duration in Group 2 and 3 was significantly lower than those in Group 1 (P < 0.05). The incidence of myasthenia crisis in Group 3 was significantly lower than that in Groups  2 and 3 (P < 0.05). The procedure with a smaller transverse sternal incision at the second intercostal level (Group 3) is a safer method for patients with MG. The combination of this procedure with the new typing and staging methods proposed by our group could facilitate the selection  of operation indications and opportunity, resulting in the lower incidence of myasthenia crisis and mortality. Our new procedure is well deserved to be a preferential selection by other hospitals.
authors.affiliation: Department of Thoracic Surgery, The Second Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China.
authors.forename: Xin-Zheng
authors.initials: XZ
authors.lastname: Cui
authors.forename: Xin-Ying
authors.initials: XY
authors.lastname: Ji
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Kun-Peng
authors.initials: KP
authors.lastname: Yang
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Bai
authors.forename: Hong-Bing
authors.initials: HB
authors.lastname: Ma
authors.forename: Tao
authors.initials: T
authors.lastname: Li
authors.forename: Qing-Yong
authors.initials: QY
authors.lastname: Zhang
mesh_terms: D000293:Adolescent; D000328:Adult; D016063:Blood Loss, Surgical; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009157:Myasthenia Gravis / Q000145:classification* / Q000175:diagnosis / Q000601:surgery*; D061646:Operative Time; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013249:Sternum / Q000601:surgery*; D013934:Thymectomy / Q000379:methods*; D013945:Thymoma / Q000601:surgery; D013953:Thymus Neoplasms / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult