Impact of the surgical approach to thymectomy upon complete stable remission rates in myasthenia gravis: a meta-analysis

Objectives: To determine whether any of the available operative techniques confer variable chances for complete stable remission (CSR) in myasthenia gravis (MG), we performed a meta-analysis of all comparative studies of surgical approaches. Methods: Meta-analysis of all studies providing comparative data on thymectomy approaches, with CSR reported and minimum 3 years mean follow-up. Results: 12 cohort studies and one randomized clinical trial, containing 1598 patients, met entry criteria. At 3 years, CSR from MG was similar following VATS extended vs. both basic (RR 1.00, p=1.00, 95% CI 0.39-2.58) and extended (RR 0.96, p=0.74, CI: 0.72-1.27) transsternal approaches. CSR at 3 years was also similar following extended transsternal vs. combined transcervical-subxiphoid (RR 1.08, p=0.62, CI: 0.8-1.44) approaches. VATS extended approaches remained statistically equivalent to extended transsternal approaches through 9 years of follow-up (RR 1.51, p=0.05, CI: 0.99-2.30). The only sign...研究目的：为明确现有手术术式是否会对重症肌无力（myasthenia gravis, MG）患者获得完全稳定缓解（complete stable remission, CSR）的概率产生差异，我们针对所有手术入路的对比研究开展了一项荟萃分析。 研究方法：针对所有提供胸腺切除术不同入路对比数据、且报告了完全稳定缓解结局、平均随访时长至少3年的研究进行荟萃分析。 研究结果：共有12项队列研究与1项随机临床试验符合纳入标准，涉及1598例患者。术后3年时，电视辅助胸腔镜手术（video-assisted thoracoscopic surgery, VATS）扩大入路与经胸骨基本入路（RR=1.00, p=1.00, 95%CI: 0.39-2.58）、经胸骨扩大入路（RR=0.96, p=0.74, 95%CI: 0.72-1.27）患者的重症肌无力完全稳定缓解率无显著差异。经胸骨扩大入路与经颈-剑突联合入路患者的术后3年完全稳定缓解率亦无显著差异（RR=1.08, p=0.62, 95%CI: 0.80-1.44）。截至术后9年随访，VATS扩大入路与经胸骨扩大入路患者的完全稳定缓解率仍无统计学差异（RR=1.51, p=0.05, 95%CI: 0.99-2.30）。仅有的……