Clinical Characteristics On515Patients With Myasthenia Gravis(a Retrospective Study) And Systematic Review Of Video-assisted Thoracoscopic Surgery(VATS)

Objective：To study the onset rule, clinical characteristics and treatment effect of515myasthenia gravis(MG) patients. To assess the clinical effectiveness of minimally invasivesurgery (VATS) and transsternal thymectomy(TT) in the treatment of myasthenia gravis.Thestudy is significant for raising clinical treatment level.Methods：Clinical data about515MG patients admitted to our hospital in the10yearswere retrospectively analyzed. The domestic and overseas articles about VATS and TT in thetreatmet of MG were retrived.Meta-analyses were conducted by using RevMan5.2.6software.Results：Among515patients, male-to-female ratio was1:1.18, MG occurred in515patients at the age of (43.1±13.7) years. Accoding to Induction and exacerbation factors，without inducement was in51.07%, infections was in23.11%, drug discontinuance withoutthe guidance was in4.66%, tired and pressure was in13.20%, trauma was in1.75%, surgerieswas in5.63%of patients. Eyes symptom was in64.47%, dysphagia was in9.13%, dysmasesiswas in8.73%, acroparalysis was in14.76%of patients’ s innitial symptom. According tomodified Ossermann classifications, type Ⅰ was in20.78%, type Ⅰ a was in34.17%, type Ⅰbwas in29.90%, type Ⅲ was in9.13%, type Ⅲ was in3.69%and type Ⅲwas in2.33%ofpatients. Myasthenic crisis occurred in10.16%of patients. Positive rate of neostigmine testwas93.54%. Positive rate of RNES was58.46%. Positive rate of Jolly test was93.79%.Positive rate of AChR-Ab was2.04%. Thymic hyperplasia, Thymoma and thymiccarcinomawas in28.71%of patients. No significant difference of efficacy was found among the fourgroups. A total of28studys were included.Result of Meta-analysis showed that no significantdifference of operation time(P＝0.08) and efficacy(P＝0.98) was found,VATS was less thanTT in blood loss(P＜0.00001，MD＝-56.61，95%CI[-64.59，-48.64]), duration of chest tube drainage(P＝0.003，MD＝-0.60，95%CI[-0.99,-0.21]) and hospital stay(P＜0.00001，MD＝-3.51，95%CI[-4.51,-2.50]).Conclusion MG occurs mainly in yaung or middle-aged individuals and more infemales than in males. Most MG occured without inducement.Most MG patients were startingwith Ocular signs. Most MG patients was Type Ⅰof Ossermann classifications. Neostigminetest, RNES, Jolly test, AChR-Ab and chest imageological examination were contribute to MGdiagnosis. No significant difference of efficacy was found among cholinesterase inhibitor,corticosteoids, intravenous immunoglobulin and thymectomy. No significant difference ofoperation time and efficacy was found,VATS was better than TT in blood loss, duration ofchest tube drainage and hospital stay.