Objective To analyze the risk factors of myasthenia gravis crisis after thymectomy with myasthenia gravis (MG).Methods Sixty-five myasthenia gravis patients who had myasthenia crisis after thymectomy in Xuanwu Hospital, Capital Medical University from June 2006 to June 2019 were retrospectively enrolled, including 31 males and 34 females, aged 15-78 (45.7±17.8) years. The relationship between myasthenia crisis after thymectomy and surgical option, operation time, pathological type, et al. were anylyzed.Results Operation time and pathological type were the predictive factors of postoperative myasthenic crisis. The area under receiver operating characteristic curve (AUC) of MG type (Osserman) was 0.676, the cut-off value wasⅡB type, the sensitivity was 37.5%, the specificity was 90.5%, and the Youden’s index was 0.280. The AUC of thymoma stage (Masaoka) was 0.682, cut-off value was stageⅡ, sensitivity was 62.5%, specificity was 66.7%, and Youden’s index was 0.292. The AUC of blood loss was 0.658, the cut-off value was 90 mL, the sensitivity was 87.5%, the specificity was 69.6%, and the Youden’s index was 0.304.Conclusion Preoperative MG classification, pathological type, operation time and blood loss are the risk factors of postoperative myasthenic crisis. Therefore, adequate preoperative preparation, rapid and careful intraoperative operation and active postoperative management can reduce the occurrence of postoperative myasthenic crisis.
Citation：
LIU Baodong, ZHANG Yi, SU Lei, WANG Ruotian, LIU Lei, QIAN Kun, LI Yuanbo. Analysis of risk factors of myasthenia crisis after thymectomy in patients with myasthenia gravis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(2): 195-198. doi: 10.7507/1007-4848.201909084
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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Ando T, Omasa M, Kondo T, et al. Predictive factors of myasthenic crisis after extended thymectomy for patients with myasthenia gravis. Eur J Cardiothoracic Surg, 2015, 48(5): 705-709.
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Lu W, Yu T, Longhini F, et al. Preoperative risk factors for prolonged postoperative ventilation following thymectomy in myasthenia gravis. Int J Clin Exp Med, 2015, 8(8): 13990-13996.
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Li K, Qian K, Feng Y, et al. Predictive factors of prolonged mechanical ventilation, overall survival, and quality of life in patients with post-thymectomy myasthenic crisis. World J Surg Oncol, 2017, 15(1): 150.
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Chigurupati K, Gadhinglajkar G, Sreedhar R, et al. Criteria for postoperative mechanical ventilation after thymectomy in patients with myasthenia gravis: A retrospective analysis. J Cardiothoracic Vasc Anesth, 2018, 32(1): 325-330.
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Xue L, Wang L Dong J, et al. Risk factors of myasthenic crisis after thymectomy for thymoma patients with myasthenia gravis. Eur J Cardiothoracic Surg, 2017, 52(4): 692-697.
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- 1. Sanders DB, Wolfe GI, Benatar ME, et al. International consensus guidance tor management of myasthenia gravls: Executive summary. Neurology, 2016, 87(4): 419-425.
- 2. Binks S, Vincent A, Palace J. Myasthenia gravis: a clinical-immunological update. J Neurol, 2016, 263(4): 826-834.
- 3. 刘宝东, 支修益. 重症肌无力的外科治疗进展. 中华临床医师杂志(电子版), 2009, (11): 1805-1810.
- 4. 刘宝东, 许庆生, 李建新, 等. 扩大胸腺切除治疗重症肌无力的围手术期管理. 中华医药荟萃杂志, 2002, 1(3): 14-16.
- 5. Cataneo AJM, Felisberto G Jr, Cataneo DC. Thymectomy in nonthymomatous myasthenia gravis - systematic review and meta-analysis. Orphanet J Rare Dis, 2018, 13(1): 99.
- 6. Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med, 2016, 375(6): 511-522.
- 7. Leuzzia G, Meaccib E, Cusumanoc G, et al. Thymectomy in myasthenia gravis: proposal for a predictive score of postoperative myasthenic crisis. Eur J Cardiothoracic Surg, 2014, 45(4): e76-e88.
- 8. Ando T, Omasa M, Kondo T, et al. Predictive factors of myasthenic crisis after extended thymectomy for patients with myasthenia gravis. Eur J Cardiothoracic Surg, 2015, 48(5): 705-709.
- 9. Lu W, Yu T, Longhini F, et al. Preoperative risk factors for prolonged postoperative ventilation following thymectomy in myasthenia gravis. Int J Clin Exp Med, 2015, 8(8): 13990-13996.
- 10. Li K, Qian K, Feng Y, et al. Predictive factors of prolonged mechanical ventilation, overall survival, and quality of life in patients with post-thymectomy myasthenic crisis. World J Surg Oncol, 2017, 15(1): 150.
- 11. Chigurupati K, Gadhinglajkar G, Sreedhar R, et al. Criteria for postoperative mechanical ventilation after thymectomy in patients with myasthenia gravis: A retrospective analysis. J Cardiothoracic Vasc Anesth, 2018, 32(1): 325-330.
- 12. Xue L, Wang L Dong J, et al. Risk factors of myasthenic crisis after thymectomy for thymoma patients with myasthenia gravis. Eur J Cardiothoracic Surg, 2017, 52(4): 692-697.
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