Thymectomy in the management of myasthenia gravis

被引:68
作者
Jaretzki, A [1 ]
Steinglass, KM [1 ]
Sonett, JR [1 ]
机构
[1] Columbia Univ, Coll Phys & Surg, Columbia Presbyterian Med Ctr, New York Presbyterian Hosp,Dept Surg, New York, NY USA
关键词
nonthymomatous myasthenia gravis; transcervical thymectomy; transsternal thymectomy; video-assisted thoracic surgery "VATS" thymectomy; life table analysis; crude analysis; nonrandom prospective studies;
D O I
10.1055/s-2004-829596
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
There continues to be a debate regarding the effectiveness of thymectomy in the treatment of nonthymomatous myasthenia gravis (MG) and, when undertaken, which thymectomy technique is the procedure of choice. The debate persists primarily because of the lack of controlled prospective studies. Analysis has been complicated by the absence, until very recently, of accepted objective definitions of severity of the illness and response to therapy as well as variable patient selection, timing of surgery, type of surgery, and methods of analysis of results. Without resolution of these issues by properly controlled prospective studies, there can be no unequivocal determination of the effectiveness of thymectomy or valid comparison of the various thymectomy techniques. In this review, based on previous analyses, attempts will be made to clarify some of the controversial issues concerning thymectomy for nonthymomatous MG and make limited recommendations based on the best available evidence.
引用
收藏
页码:49 / 62
页数:14
相关论文
共 144 条
[1]   THYMECTOMY IN JUVENILE MYASTHENIA-GRAVIS [J].
ADAMS, C ;
THEODORESCU, D ;
MURPHY, EG ;
SHANDLING, B .
JOURNAL OF CHILD NEUROLOGY, 1990, 5 (03) :215-218
[2]   A treatment algorithm for autoimmune myasthenia gravis in childhood [J].
Andrews, PI .
MYASTHENIA GRAVIS AND RELATED DISEASES: DISORDERS OF THE NEUROMUSCULAR JUNCTION, 1998, 841 :789-802
[3]   RACE, SEX, AND PUBERTY INFLUENCE ONSET, SEVERITY, AND OUTCOME IN JUVENILE MYASTHENIA-GRAVIS [J].
ANDREWS, PI ;
MASSEY, JM ;
HOWARD, JF ;
SANDERS, DB .
NEUROLOGY, 1994, 44 (07) :1208-1214
[4]   MAXIMAL THYMECTOMY FOR MYASTHENIA-GRAVIS [J].
ASHOUR, MH ;
JAIN, SK ;
KATTAN, KM ;
ALDAEEF, AQ ;
JABBAR, MSA ;
ALTAHAN, AR ;
ALMOALLAMI, M .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 1995, 9 (08) :461-464
[5]   Totally endoscopic robotic thymectomy for myasthenia gravis [J].
Ashton, RC ;
McGinnis, KM ;
Connery, CP ;
Swistel, DG ;
Ewing, DR ;
DeRose, JJ .
ANNALS OF THORACIC SURGERY, 2003, 75 (02) :569-571
[6]   THYMOMA FOLLOWING TRANS-CERVICAL THYMECTOMY FOR MYASTHENIA-GRAVIS [J].
AUSTIN, EH ;
OLANOW, CW ;
WECHSLER, AS .
ANNALS OF THORACIC SURGERY, 1983, 35 (05) :548-550
[7]   A comparison of observational studies and randomized, controlled trials. [J].
Benson, K ;
Hartz, AJ .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (25) :1878-1886
[8]   Outcome analysis using hazard function methodology [J].
Blackstone, EH .
ANNALS OF THORACIC SURGERY, 1996, 61 (02) :S2-S7
[9]   Comparing apples and oranges [J].
Blackstone, EH .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2002, 123 (01) :8-15
[10]   Clinical-Pathologic Conference: Use and choice of statistical methods for the clinical study, "Superficial adenocarcinoma of the esophagus" [J].
Blackstone, EH ;
Rice, TW .
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 2001, 122 (06) :1063-1076