ﺑﺮرﺳﻲ ﻧﺘﺎﻳﺞ درﻣﺎن ﺑﻌﺪ از ﺗﺎﻳﻤﻜﺘﻮﻣﻲ از ﻃﺮﻳﻖ ﮔﺮدن در ﻣﻴﺎﺳﺘﻨﻲ ﮔﺮاو در ﺑﻴﻤﺎرﺳﺘﺎن اﻟﺰﻫﺮا)س( اﺻﻔﻬﺎن ﻃﻲ ﺳﺎل ﻫﺎي 1382-1377

valuation of the Post-Operative Remission and Complications after Transcervical Thymectomy in Al-Zahra Hospital during 1996 until 2003

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﻫﻨﻮﺯ ﺑﻬﺘﺮﻳﻦ ﺭﻭﺵ ﺑﺮﺍﻱ ﻋﻤﻞ ﺗﺎﻳﻤﻜﺘﻮﻣﻲ ﺩﺭ ﻣﻴﺎﺳﺘﻨﻲ ﮔﺮﺍﻭ )MG( ﻣﻮﺭﺩ ﺑﺤﺚ ﻣﻲ ﺑﺎﺷﺪ. ﺑﺮﺧﻲ ﺟﺮﺍﺣﺎﻥ ﻣﺨﺎﻟﻒ ﺍﺳﺘﻔﺎﺩﻩ ﺍﺯ ﺭﻭﺵ ﺗﺎﻳﻤﻜﺘﻮﻣﻲ ﺍﺯ ﺭﺍﻩ ﮔﺮﺩﻥ ﺑﻪ ﺧﺎﻃﺮ ﺍﺣﺘﻤﺎﻝ ﺑﺎﻗﻲ ﮔﺬﺍﺷﺘـﻦ ﺗﻮﻣـﻮﺭ ﻭ ﺍﺣﺘﻤﺎﻝ ﺑﻴﺸﺘﺮ ﺑﺮﺍﻱ ﻋـﺪﻡ ﭘﺴﺮﻓﺖ ﻛﺎﻣﻞ ﺑﻴﻤﺎﺭﻱ ﻣﻲ ﺑﺎﺷﻨﺪ. ﺩﺭ ﺍﻳﻦ ﻣﻘﺎﻟﻪ، ﻣﺎ ﮔﺮﻭﻩ ﻧﺴﺒﺘﹰﺎ ﺑﺰﺭﮔﻲ ﺍﺯ ﺑﻴﻤﺎﺭﺍﻥ MG ﻛﻪ ﺑﺎ ﺗﺎﻳﻤﻜﺘﻮﻣﻲ ﺍﺯ ﻃﺮﻳﻖ ﮔﺮﺩﻥ ﻋﻤﻞ ﺷﺪﻩ ﺍﻧﺪ ﺭﺍ ﺍﺯ ﻧﻈﺮ ﻧﺘﺎﻳﺞ ﻭ ﻋﻮﺍﺭﺽ ﻭ ﻣﻴﺰﺍﻥ ﺑﻬﺒﻮﺩﻱ ﻭ ﻣﻘﺎﻳﺴﻪ ﺁﻥ ﺑﺎ ﺭﻭﺵ ﺗﺮﺍﻧﺲ ﺍﺳﺘﺮﻧﺎﻝ ﻣﻮﺭﺩ ﺑﺮﺭﺳﻲ ﻗﺮﺍﺭ ﻣﻲ ﺩﻫﻴـﻢ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺍﻳﻦ ﻣﻄﺎﻟﻌﻪ ﻳﻚ ﺑـﺮﺭﺳﻲ ﺗﻮﺻﻴﻔﻲ ـ ﺗﺤﻠﻴﻠـﻲ ﺑﺮ ﺭﻭﻱ 37 ﺑﻴﻤـﺎﺭ ﺍﺳﺖ ﻛﻪ ﺑﺨﺎﻃـﺮ ﻣﻴﺎﺳﺘﻨﻲ ﮔـﺮﺍﻭ ﺑﻴﻦ ﺳﺎﻝ ﻫﺎﻱ 1377 ﺗﺎ 1382 ﺩﺭ ﺑﻴﻤـﺎﺭﺳﺘﺎﻥ ﺍﻟﺰﻫـﺮﺍ ﺍﺻﻔﻬـﺎﻥ ﺗﺤـﺖ ﻋﻤـﻞ ﺗﺎﻳﻤﻜﺘﻮﻣﻲ ﺍﺯ ﻃﺮﻳﻖ ﮔـﺮﺩﻥ ﻗـﺮﺍﺭ ﮔﺮﻓﺘﻨـﺪ. ﺍﻳﻦ ﺑﻴﻤـﺎﺭﺍﻥ ﺍﺯ ﻧﻈﺮ ﺳﻦ، ﺟﻨﺲ، ﻧﻮﻉ ﺩﺍﺭﻭﻱ ﻣﺼـﺮﻓﻲ، ﻣـﺪﺕ ﺯﻣﺎﻥ ﻋﻤﻞ، ﺍﻃﻼﻋـﺎﺕ ﭘﻴﺮﺍﻣـﻮﻥ ﻋﻤﻞ ﻭ ﻋـﻮﺍﺭﺽ ﻋﻤـﻞ ﺑﺮﺭﺳﻲ ﺷـﺪﻧﺪ. ﺍﺯ ﺁﻧﺎﻟﻴـﺰ ﻛﺎﭘﻼﻥ ﻣﺎﻳﺮ ﺟﻬﺖ ﺑﺮﺭﺳﻲ ﺯﻣﺎﻥ ﻋﻤﻞ ﺗﺎ ﺑﻬﺒـﻮﺩﻱ ﺑﻴﻤـﺎﺭﺍﻥ ﺍﺳﺘﻔـﺎﺩﻩ ﺷـﺪ. ﺩﺭ ﺁﻧﺎﻟﻴـﺰ ﺩﺍﺩﻩ ﻫﺎﻱ ﺍﻳﻦ ﭘﮋﻭﻫﺶ P <0.05 ﺑﻪ ﻋﻨـﻮﺍﻥ ﺳﻄـﺢ ﻣﻌﻨﻲ ﺩﺍﺭ ﺩﺭ ﻧﻈﺮ ﮔﺮﻓﺘﻪ ﺷﺪ. ﻳﺎﻓﺘﻪ ﻫﺎ: ﺍﺯ 37 ﺑﻴﻤﺎﺭ 65/8 ﺯﻥ ﺑﻮﺩﻧﺪ. ﺳﻦ ﻣﺘﻮﺳﻂ 31/36+10/4 ﺳﺎﻝ ﺑﻮﺩ. ﻣﺮﮒ ﻭ ﻣﻴـﺮ ﺩﺭ ﺣﻮﺍﻟﻲ ﺟﺮﺍﺣﻲ ﻭﺟﻮﺩ ﻧﺪﺍﺷﺖ ﻭ ﻋﻮﺍﺭﺽ ﻧﺎﺷﻲ ﺍﺯ ﻋﻤﻞ 13/7% ﺑﻮﺩ. ﻃﻮﻝ ﻣﺘﻮﺳﻂ ﺍﻗﺎﻣﺖ ﺩﺭ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ 5/5+1/44 ﺭﻭﺯ ﻭ ﻣﻴﺎﻧﮕﻴﻦ ﭘﻴﮕﻴـﺮﻱ 35/39+20/34 ﻣﺎﻩ ﺑﻮﺩ. ﻣﻴﺰﺍﻥ ﺑﻬﺒﻮﺩﻱ ﻛﺎﻣﻞ ﺩﺭ ﺑﻴﻤﺎﺭﺍﻥ 12/5 ﺑﻮﺩ. ﺑﺮ ﺍﺳﺎﺱ ﺁﺯﻣﻮﻥ ﻛﺎﭘﻼﻥ ﻣﺎﻳﺮ 70/6 ﺑﻌﺪ ﺍﺯ 2 ﺳﺎﻝ ﻭ 85/3 ﺑﻌﺪ ﺍﺯ 5 ﺳﺎﻝ ﺑﻬﺒﻮﺩﻱ ﻳﺎﻓﺘﻨﺪ. ﻫﻤﮕﻲ ﺑﻴﻤﺎﺭﺍﻥ ﺍﺯ ﻧﻮﻉ ﺑﺮﺵ ﺟﺮﺍﺣﻲ ﺭﺿﺎﻳﺖ ﻛﺎﻣﻞ ﺩﺍﺷﺘﻨﺪ. ﺩﺭ ﺁﻧﺎﻟﻴﺰ ﺍﻃﻼﻋﺎﺕ ﺷﺪﺕ ﺑﻴﻤﺎﺭﻱ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﻭ ﭘﺎﺗﻮﻟﻮﮊﻱ ﺑﺎﻓﺘﻲ ﺑﻄﻮﺭ ﻭﺍﺿﺢ ﺑﺎ ﻣﻴﺰﺍﻥ ﺑﻬﺒﻮﺩﻱ ﻛﺎﻣﻞ ﺑﺮ ﺍﺳﺎﺱ ﺁﺯﻣﻮﻥ ﻛﺎﭘﻼﻥ ﻣﺎﻳﺮ ﺍﺭﺗﺒﺎﻁ ﺩﺍﺷﺘﻨﺪ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺑﺮ ﺍﺳﺎﺱ ﻧﺘﺎﻳﺞ ﻓﻮﻕ ﻧﺸﺎﻥ ﺩﺍﺩﻩ ﻣﻲ ﺷﻮﺩ ﻛﻪ ﺑﻬﺒﻮﺩﻱ ﻛﺎﻣﻞ ﭘﺲ ﺍﺯ ﺗﺎﻳﻤﻜﺘﻮﻣﻲ ﺍﺯ ﺭﺍﻩ ﮔﺮﺩﻥ ﺑﺎ ﻧﺘﺎﻳﺞ ﺣﺎﺻﻞ ﺍﺯ ﺭﻭﺵ ﺗﺎﻳﻤﻜﺘﻮﻣﻲ ﺗﺮﺍﻧﺲ ﺍﺳﺘﺮﻧﺎﻝ ﻣﺸﺎﺑﻪ ﺑﻮﺩﻩ ﻭ ﻣﺸﺨﺼﺎﹰ ﻋﻮﺍﺭﺽ ﺑﻌﺪ ﺍﺯ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﺩﺭ ﺍﻳﻦ ﮔﺮﻭﻩ ﻛﻤﺘﺮ ﺍﺳﺖ. ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﺷﺪﺕ ﺑﻴﻤﺎﺭﻱ ﻛﻤﺘﺮ، ﺍﺣﺘﻤﺎﻝ ﺑﻬﺒﻮﺩﻱ ﻛﺎﻣﻞ ﺩﺭ ﺁﻧﻬﺎ ﺩﺭ ﺭﻭﺵ ﺗﺎﻳﻤﻜﺘﻮﻣﻲ ﺍﺯ ﺭﺍﻩ ﮔﺮﺩﻥ ﺑﻴﺸﺘﺮ ﺍﺳﺖ. ﺩﺭ ﺻﻮﺭﺕ ﭘﺎﺗﻮﻟﻮﮊﻱ ﻧﺮﻣﺎﻝ ﺑﺎﻓﺖ ﺗﻴﻤﻮﺱ ﺩﺭ ﺗﺎﻳﻤﻜﺘﻮﻣﻲ، ﺍﺣﺘﻤﺎﻝ ﺑﻬﺒﻮﺩﻱ ﻛﺎﻣﻞ، ﺑﻴﺸﺘﺮ ﺍﺯ ﭘﺎﺗﻮﻟﻮﮊﻱ ﺑﺎﻓﺘﻲ ﺗﻴﻤﻮﻣﺎ ﻣﻲ ﺑﺎﺷﺪ.

troduction & Objective: It remains controversial whether transcervical thymectomy offers results equivalent to thymectomy by way of median sternotomy in the treatment of myasthenia gravis. Furthermore preoperative prognostic factors have not been clearly defined. Materials & Methods: This study is a retrospective chart review and interview of 37 patients completing transcervical thymectomy for myasthenia between 1996 and 2003 out of age, sex, drug resumption, operation time and complication were studied. Data were analyzed by Kaplan-Meier test and P<0.05 was significant. Results: From 37 patients, there were 65.8% women. Mean of age (+SD) was 31.36+10.4. There was no preoperative mortality, we had morbidities in 10.8% of patients. Mean length of stay was 5.5+1.44 days and mean follow up time was 35.39+20.44 months. The crude cumulative complete remission was 11.7%. Kaplain - Meier estimates of remission were 70.6% and 85.3% at 2 and 5 years, respectively. The significant relation was present between pathology of thymus, type of drug resumption before-operation and remission. Conclusions: Overall, extended transcervical thymectomy offers results that are comparable to those published for transternal procedure. Also, there is controversial about preoperatively predictor factor for remission.