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Vol. 37. Issue 5.
Pages 235-239 (May 2001)
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Vol. 37. Issue 5.
Pages 235-239 (May 2001)
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Timectomía en la miastenia gravis
Thymectomy in myasthenia gravis
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P. León Atance*, F. González Aragoneses, N. Moreno Mata, E. García Fontán, D. León Medina, J.M. Naranjo Gómez, E. Orusco Palomino, E. Folqué Gómez
Servicios de Cirugía Torácica Hospital General Universitario Gregorio Marañón. Madrid
J.L. Muñoz Blanco*
* Neurología. Hospital General Universitario Gregorio Marañón. Madrid
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Objetivo

Analizar los resultados de la timectomía en pa-cientes con miastenia gravis.

Material y métodos

Entre junio de 1987 y junio de 1998, se intervinieron en nuestro servicio 35 pacientes con miastenia gravis, en 10 de los cuales se asociaban timomas. Los pacientes se clasificaron en el preoperatorio según la clasificación de Osserman (dos grado I, 20 grado IIA, 11 grado IIB y dos grado III). En todos se realizó timectomía ampliada por esternotomía media.

Resultados

En 3 pacientes hubo complicaciones posto-peratorias (una aplasia medular, una reintubación postope-ratoria y una crisis miasténica). Tras una mediana de segui-miento de 89 meses, el 22,8% estaba en remisión completa y el 97,1% había mejorado. Los resultados son similares en los 10 pacientes con timoma (un 20% de remisiones comple-tas y un 90% de mejorías). Según la clasificación de DeFilip-pi un 22,8% se encontraba en clase 1; un 22,8%, en clase 2; un 51,4%, en clase 3, y un 2,8%, en clase 4. Según la clasifi-cación de Osserman, 9 pacientes presentaban el grado pre-vio a la cirugía, 12 habían mejorado un grado, 10 habían mejorado 2 grados, 3 habían mejorado 3 grados y un pa-ciente había mejorado 4 grados.

Conclusiones

La timectomía es una opción terapéutica adecuada en el tratamiento multidisciplinario de los pacien-tes con miastenia gravis y es el tratamiento de elección en los pacientes en que se asocian timomas. El porcentaje de com-plicaciones intra y postoperatorias es bajo, y se obtiene un índice elevado de mejorías clínicas.

Palabras clave:
Miastenia gravis
Timectomía
Timoma
Objective

To analyze outcome after thymectomy in pa-tients with myasthenia gravis (MG).

Material and methods

Thirty-five patients with MG underwent surgery in our service between June 1987 and June 1998. Ten had associated thymomas. Preoperative Os-serman classification showed 2 at level I, 20 at level IIA, 11 at level IIB and 2 at level III. Extended thymectomy th-rough a medial sternotomy was performed in all.

Results

Postoperative complications developed in three patients (1 medullary aplasia, 1 postoperative reintubation, 1 myasthenic crisis). Mean follow-up was 89 months, with 22.8% achieving complete remission and 97.1% reporting improvements. The results were similar in the 10 patients with thymomas (20% full remission and 90% showing im-provement). By DeFilippi classification, 22.8% were in class 1, 22.8% in class 2, 51.4% in class 3 and 2.8% in class 4. By Osserman classification, 9 were in the same category before and after surgery, 12 had improved one level, 10 had impro-ved 2 levels, 3 had improved 3 levels and 1 patient had im-proved 4 levels.

Conclusions

Thymectomy is an appropriate therapeutic procedure in the multidisciplinary treatment of patients with MG and it is the approach of choice for patients with associated thymomas. The intra- and post-operative compli-cation rate is low and the rate of clinical improvement is high.

Keywords:
Myasthenia gravis
Thymectomy
Thymoma
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