تلخیص
Objective: To determine outcome and postoperative complications of trans-sternal thymectomy for
myasthenia gravis.
Study Design: Experimental, prospective.
Place and Duration of Study: The study was conducted at Department of Surgery, Pakistan Institute of Medical
Sciences (PIMS), Islamabad from June 2009 to June 2012.
Materials and Methods: We included 30 consecutive patients from all age groups either coming to Surgical
outpatient clinic or referred from Neurolgy unit having generalized myasthenia gravis between 12-55 years of
age, thymic mass on radiology or poor medical control of disease with no contra indications to surgery. Patients
unfit for anaesthesia due to any reason or inoperable thymic tumour were excluded. We studied outcome and
post-operative complications in all patients after total thymectomy through trans-sternal approach for 24-40
months. All patients were assessed for haemorrhage, transfusion requirement, shock, myasthenia crisis,
respiratory infection, wound infection, delayed healing of wound and dehiscence and pulmonary embolism.
Remission of disease was assessed according to De Filippi classification. The data was collected by post
graduate trainees on a pre-designed proforma and analysed by SPSS 10. The descriptive statistics were applied
and results were shown in percentage.
Results: In total 30 patients, mean age was 37±8.6 years. All patients needed at least two units of blood
transfusion. We observed pleural damage in 20 patients (66.67%), respiratory infection in 20 (66.67%),
myasthenia crisis in 8 (26.7%), minor wound infection in 6 (20%), mortality in 4 patients with
th th
carcinoma(13.33%). Artificial ventilation discontinued within 24 hours in 22, at 7 day in 4 and at 14 days in 4
patients. Wound dehiscence occurred in 1(3.33%), cardiac arrest in 1 (3.33%). Mean hospital stay was 13.6 (7-
45) days. Six patients (20%) were symptom free without drugs and 9 patients (30%) were symptom free with
drugs at 2 years.
Conclusion: Trans-sternal total thymectomy provides good results for symptom control in benign thymic
conditions. The major complication is haemorrhage needing transfusion. Other complications can be managed
successfully by conservative treatment.