Kết quả điều trị và một số yếu tố liên quan ở người bệnh nhược cơ sau phẫu thuật cắt tuyến ức

Myasthenia gravis (MG) is a chronic autoimmune disorder characterized by fluctuating muscle weakness, significantly impacting patients' quality of life. Thymectomy, the surgical removal of the thymus gland, is a widely recognized and often recommended treatment for MG, particularly in cases involving thymoma or thymic hyperplasia. While its efficacy in inducing remission and improving symptoms has been well-documented globally, local insights into treatment outcomes and the specific factors influencing them remain crucial for optimizing patient care. This study aims to evaluate the treatment outcomes of thymectomy in Vietnamese myasthenia gravis patients and identify associated factors that predict improvement. Understanding these elements is vital for refining clinical guidelines and enhancing therapeutic strategies.

Neurologists, thoracic surgeons, internal medicine physicians, medical researchers, and students interested in myasthenia gravis and thymectomy outcomes.

This study investigated the treatment outcomes and associated prognostic factors in 66 patients with myasthenia gravis who underwent thymectomy at Bach Mai Hospital between October 2019 and January 2023. Employing a retrospective design, the research analyzed various outcome measures including improvement rates, long-term stable rates, pharmacological stable rates, minimal manifestation rates, worsening conditions, and mortality. The average time to improvement after thymectomy was found to be 20.25 months, with an overall improvement rate of 77.3%. Key findings revealed several factors significantly correlated with improved outcomes. Patients who underwent surgery within one year of symptom onset demonstrated a 5.04 times higher likelihood of improvement (p<0.05). Furthermore, the absence of bulbar or respiratory symptoms, such as dysphagia (OR=9.80) and dyspnea (OR=5.00), was strongly associated with better prognosis. Notably, patients presenting in mild clinical stages (I and IIA) experienced a significantly higher probability of improvement compared to those in more advanced stages (OR=14.67 for Stage I, OR=12.67 for Stage IIA, p<0.05). These results underscore the importance of early surgical intervention and careful patient selection based on clinical and paraclinical characterization for maximizing therapeutic benefits. The findings provide valuable data for clinicians to better counsel patients and tailor treatment plans, ultimately contributing to improved management strategies for myasthenia gravis patients undergoing thymectomy.