Chinese clinical expert consensus on surgical treatment of myasthenia gravis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 TAN Qunyou ¹ , TAO Shaolin ¹ ,  LIU Baodong ² , LIU Yangchun ³ , Representatives of the Consensus Writing Group of China Myasthenia Gravis Alliance

1. Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, P. R. China;
2. Department of Thoracic Surgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, P. R. China;
3. Department of Thoracic Surgery, Jiangxi Provincial People's Hospital, Nanchang, 330006, P. R. China;

Corresponding?author：

TAN Qunyou, Email: tanfriends@163.com; LIU Baodong, Email: xwliubaodong@aliyun.com

Keywords：

Myasthenia gravis; surgical treatment; extended thymectomy; expert consensus

DOI：

10.7507/1007-4848.202202043

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Myasthenia gravis (MG) is an autoimmune disease with indefinite pathogenesis. MG is closely related to thymic diseases, and thymectomy is an important way for MG treatment. However, there are some controversies regarding thymectomy, including indications, operation opportunities, operative procedures, surgical approaches, perioperative managements, and efficacy evaluations, etc. Therefore, based on the literature and the experience of Chinese experts, this consensus has been written after careful discussion and inquiry and 29 recommendations have been made, aiming to guide surgical treatment of MG and improve the clinical outcomes.

Citation： TAN Qunyou, TAO Shaolin, LIU Baodong, LIU Yangchun, Representatives of the Consensus Writing Group of China Myasthenia Gravis Alliance. Chinese clinical expert consensus on surgical treatment of myasthenia gravis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(5): 529-541. doi: 10.7507/1007-4848.202202043 Copy

1.	Gilhus NE, Tzartos S, Evoli A, et al. Myasthenia gravis. Nat Rev Dis Primers, 2019, 5(1): 30.
2.	Deymeer F. History of myasthenia gravis revisited. Noro Psikiyatr Ars, 2020, 58(2): 154-162.
3.	中國免疫學會神經免疫分會. 中國重癥肌無力診斷和治療指南(2020版). 中國神經免疫學和神經病學雜志 2021, 28(1 ): 1-12.
4.	Kaufman AJ, Palatt J, Sivak M, et al. Thymectomy for myasthenia gravis: Complete stable remission and associated prognostic factors in over 1000 cases. Semin Thorac Cardiovasc Surg, 2016, Summer,28(2): 561-568.
5.	Remes-Troche JM, Téllez-Zenteno JF, Esta?ol B, et al. Thymectomy in myasthenia gravis: Response, complications, and associated conditions. Arch Med Res, 2002, 33(6): 545-551.
6.	Fulghum CB. Cystic tumor of the thymic region and myasthenia gravis; report of a case in which the tumor was removed. Ann Intern Med, 1950, 32(2): 327-335.
7.	Blalock A, Mason MF, Morgan HJ, et al. Myasthenia gravis and tumors of the thymic region: Report of a case in which the tumor was removed. Ann Surg, 1939, 110(4): 544-561.
8.	Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med, 2016, 375(6): 511-522.
9.	Newsom-Davis J, Cutter G, Wolfe GI, et al. Status of the thymectomy trial for nonthymomatous myasthenia gravis patients receiving prednisone. Ann N Y Acad Sci, 2008, 1132: 344-347.
10.	Cataneo AJM, Felisberto G, Cataneo DC. Thymectomy in nonthymomatous myasthenia gravis—Systematic review and meta-analysis. Orphanet J Rare Dis, 2018, 13(1): 99.
11.	Kerty E, Elsais A, Argov Z, et al. EFNS/ENS guidelines for the treatment of ocular myasthenia. Eur J Neurol, 2014, 21(5): 687-693.
12.	Narayanaswami P, Sanders DB, Wolfe G, et al. International consensus guidance for management of myasthenia gravis: 2020 update. Neurology, 2021, 96(3): 114-122.
13.	Murai H, Utsugisawa K, Nagane Y, et al. Rationale for the clinical guidelines for myasthenia gravis in Japan. Ann N Y Acad Sci, 2018, 1413(1): 35-40.
14.	Sussman J, Farrugia ME, Maddison P, et al. Myasthenia gravis: Association of British Neurologists' management guidelines. Pract Neurol, 2015, 15(3): 199-206.
15.	Melzer N, Ruck T, Fuhr P, et al. Clinical features, pathogenesis, and treatment of myasthenia gravis: A supplement to the guidelines of the German Neurological Society. J Neurol, 2016, 263(8): 1473-1494.
16.	Osserman KE, Genkins G. Studies in myasthenia gravis: Review of a twenty-year experience in over 1200 patients. Mt Sinai J Med 1971; 38 (6): 497-537.
17.	曾漣乾, 黃壯士, 張斌. 胸腺瘤與胸腺瘤合并重癥肌無力的臨床探討. 中華胸心血管外科雜志, 2003, 19(1): 19-20.
18.	陳向軍, 呂傳真. 重癥肌無力的臨床分型與診斷. 新醫學, 2000, 31(5): 267-268.
19.	Cui XZ, Ji XY, Gao F, et al. Evaluation of the new classification and surgical strategy for myasthenia gravis. Am Surg, 2012, 78(12): 1329-1335.
20.	Jaretzki A, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: Recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology, 2000, 55(1): 16-23.
21.	Meriggioli MN, Sanders DB. Autoimmune myasthenia gravis: Emerging clinical and biological heterogeneity. Lancet Neurol, 2009, 8(5): 475-490.
22.	Gilhus NE, Verschuuren JJ. Myasthenia gravis: Subgroup classification and therapeutic strategies. Lancet Neurol, 2015, 14(10): 1023-1036.
23.	陳淵, 張鵬. 重癥肌無力外科治療京津冀專家共識. 天津醫藥, 2020, 48(4): 327-332.
24.	Diaz A, Black E, Dunning J. Is thymectomy in non-thymomatous myasthenia gravis of any benefit? Interact Cardiovasc Thorac Surg, 2014, 18(3): 381-389.
25.	Marx A, Pfister F, Schalke B, et al. The different roles of the thymus in the pathogenesis of the various myasthenia gravis subtypes. Autoimmun Rev, 2013, 12(9): 875-884.
26.	Zhang J, Chen Y, Zhang H, et al. Effects of thymectomy on late-onset non-thymomatous myasthenia gravis: Systematic review and meta-analysis. Orphanet J Rare Dis, 2021, 16(1): 232.
27.	Zhang J, Chen Y, Chen J, et al. AChRAb and MuSKAb double-seropositive myasthenia gravis: A distinct subtype? Neurol Sci, 2021, 42(3): 863-869.
28.	中國免疫學會神經免疫學分會, 中華醫學會神經病學分會. 神經免疫學組重癥肌無力診斷和治療中國專家共識. 中國神經免疫學和神經病學雜志, 2012, 19(6): 401-408.
29.	Sussman J, Farrugia ME, Maddison P, et al. The Association of British Neurologists' myasthenia gravis guidelines. Ann N Y Acad Sci, 2018, 1412(1): 166-169.
30.	O'Connell K, Ramdas S, Palace J. Management of juvenile myasthenia gravis. Front Neurol, 2020, 11: 743.
31.	蔣耀光, 陳建明, 王如文, 等. 單純眼肌型重癥肌無力胸腺切除的適應證探討. 中國胸心血管外科臨床雜志, 1998, 5(1): 9-10.
32.	Chu XY, Xue ZQ, Wang RW, et al. Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy. Chin Med J (Engl), 2011, 124(8): 1246-1250.
33.	Fisher K, Shah V. Pediatric ocular myasthenia gravis. Curr Treat Options Neurol, 2019, 21(10): 46.
34.	Marx A, Rüdiger T, R??ner E, et al. Ectopic thymic tissue and ectopic thymic tumors. Pathologe, 2018, 39(5): 390-397.
35.	王如文, 李昆昆, 鄧波, 等. 重癥肌無力危象的防治現狀及展望. 中華胸心血管外科雜志, 2017, 33(3): 129-132.
36.	Romi F, Aarli JA, Gilhus NE. Seronegative myasthenia gravis: Disease severity and prognosis. Eur J Neurol, 2005, 12(6): 413-418.
37.	Comacchio GM, Marulli G, Mammana M, et al. Surgical decision making: Thymoma and myasthenia gravis. Thorac Surg Clin, 2019, 29(2): 203-213.
38.	McInnis MC, Flores EJ, Shepard JA, et al. Pitfalls in the imaging and interpretation of Benign thymic lesions: How thymic MRI can help. AJR Am J Roentgenol, 2016, 206(1): W1-W8.
39.	Kim K, Jeong JH, Kim SJ. Diagnostic test accuracy of 18F-FDG PET or PET/CT for characterization of histologic type of thymic epithelial tumor: A meta-analysis. Clin Nucl Med, 2022, 47(1): 36-42.
40.	Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol, 2010, 17(7): 893-902.
41.	Kirschner PA. Alfred Blalock and thymectomy for myasthenia gravis. Ann Thorac Surg, 1987, 43(3): 348-349.
42.	Zisimopoulou P, Brenner T, Trakas N, et al. Serological diagnostics in myasthenia gravis based on novel assays and recently identified antigens. Autoimmun Rev, 2013, 12(9): 924-930.
43.	Marinkovi? G, Kroon J, Hoogenboezem M, et al. Inhibition of GTPase Rac1 in endothelium by 6-mercaptopurine results in immunosuppression in nonimmune cells: New target for an old drug. J Immunol, 2014, 192(9): 4370-4378.
44.	Maddison P, McConville J, Farrugia ME, et al. The use of rituximab in myasthenia gravis and Lambert-Eaton myasthenic syndrome. J Neurol Neurosurg Psychiatry, 2011, 82(6): 671-673.
45.	Beecher G, Anderson D, Siddiqi ZA. Rituximab in refractory myasthenia gravis: Extended prospective study results. Muscle Nerve, 2018, 58(3): 452-455.
46.	Tada M, Shimohata T, Tada M, et al. Long-term therapeutic efficacy and safety of low-dose tacrolimus (FK506) for myasthenia gravis. J Neurol Sci, 2006, 247(1): 17-20.
47.	Cortese I, Chaudhry V, So YT, et al. Evidence-based guideline update: Plasmapheresis in neurologic disorders: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 2011, 76(3): 294-300.
48.	Seyhanli A, Yavuz B, Selimoglu I, et al. Therapeutic plasma exchange in neurological diseases: Eleven years experience at a tertiary care center in Turkey. Ther Apher Dial, 2021. [Epub ahead of print].
49.	中國醫師協會醫學機器人醫師分會胸外科專業委員會籌備組, 譚群友, 陶紹霖, 等. 機器人輔助縱隔腫瘤手術中國專家共識 (2019版). 中國胸心血管外科臨床雜志, 2020, 27(2): 117-125.
50.	Campos JH. An update on robotic thoracic surgery and anesthesia. Curr Opin Anaesthesiol, 2010, 23(1): 1-6.
51.	Yamashita A, Takenami T, Kawabata M, et al. Steroid-induced rapid recovery from respiratory dysfunction in a patient with myasthenia gravis after spinal anesthesia. J Anesth, 2021, 35(1): 142-144.
52.	Kirschner PA, Osserman KE, Kark AE. Studies in myasthenia gravis. Transcervical total thymectomy. JAMA, 1969, 209(6): 906-910.
53.	Cooper JD, Al-Jilaihawa AN, Pearson FG, et al. An improved technique to facilitate transcervical thymectomy for myasthenia gravis. Ann Thorac Surg, 1988, 45(3): 242-247.
54.	宋楠, 姜格寧, 陳曉峰, 等. 經頸胸腺及胸腺瘤切除術21例. 中國胸心血管外科臨床雜志, 2011, 18(6): 578-579.
55.	de Perrot M, Bril V, McRae K, et al. Impact of minimally invasive trans-cervical thymectomy on outcome in patients with myasthenia gravis. Eur J Cardiothorac Surg, 2003, 24(5): 677-683.
56.	Wright GM, Barnett S, Clarke CP. Video-assisted thoracoscopic thymectomy for myasthenia gravis. Intern Med J, 2002, 32(8): 367-371.
57.	Zieliński M, Kuzdza? J, Szlubowski A, et al. Transcervical-subxiphoid-videothoracoscopic "maximal" thymectomy-operative technique and early results. Ann Thorac Surg, 2004, 78(2): 404-409.
58.	Mantegazza R, Baggi F, Bernasconi P, et al. Video-assisted thoracoscopic extended thymectomy and extended transsternal thymectomy (T-3b) in non-thymomatous myasthenia gravis patients: Remission after 6 years of follow-up. J Neurol Sci, 2003, 212(1-2): 31-36.
59.	Masaoka A, Yamakawa Y, Niwa H, et al. Extended thymectomy for myasthenia gravis patients: A 20-year review. Ann Thorac Surg, 1996, 62(3): 853-859.
60.	張清勇, 蘇彥河, 楊鯤鵬, 等. 胸骨橫斷第二肋間切口胸腺切除治療重癥肌無力365例體會. 鄭州大學學報(醫學版), 2005, 40(1): 15-16.
61.	Jaretzki A, 3rd, Penn AS, Younger DS, et al. "Maximal" thymectomy for myasthenia gravis. Results. J Thorac Cardiovasc Surg, 1988, 95(5): 747-757.
62.	Bulkley GB, Bass KN, Stephenson GR, et al. Extended cervicomediastinal thymectomy in the integrated management of myasthenia gravis. Ann Surg, 1997, 226(3): 324-334.
63.	Friedant AJ, Handorf EA, Su S, et al. Minimally invasive versus open thymectomy for thymic malignancies: Systematic review and meta-analysis. J Thorac Oncol, 2016, 11(1): 30-38.
64.	Qi K, Wang B, Wang B, et al. Video-assisted thoracoscopic surgery thymectomy versus open thymectomy in patients with myasthenia gravis: A meta-analysis. Acta Chir Belg, 2016, 116(5): 282-288.
65.	O'Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review and meta-analysis of robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy. Interact Cardiovasc Thorac Surg, 2019, 28(4): 526-534.
66.	Melfi FM, Fanucchi O, Mussi A. Minimally invasive mediastinal surgery. Ann Cardiothorac Surg, 2016, 5(1): 10-17.
67.	Kaba E, Cosgun T, Ayalp K, et al. Robotic thymectomy for myasthenia gravis. Ann Cardiothorac Surg, 2019, 8(2): 288-291.
68.	Romano G, Zirafa CC, Ceccarelli I, et al. Robotic thymectomy for thymoma in patients with myasthenia gravis: Neurological and oncological outcomes. Eur J Cardiothorac Surg, 2021, 60(4): 890-895.
69.	Castle SL, Kernstine KH. Robotic-assisted thymectomy. Semin Thorac Cardiovasc Surg, Winter 2008, 20(4): 326-331.
70.	Sugarbaker DJ. Thoracoscopy in the management of anterior mediastinal masses. Ann Thorac Surg, 1993, 56(3): 653-656.
71.	Coosemans W, Lerut TE, Van Raemdonck DE. Thoracoscopic surgery: The Belgian experience. Ann Thorac Surg, 1993, 56(3): 721-730.
72.	Yoshino I, Hashizume M, Shimada M, et al. Video-assisted thoracoscopic extirpation of a posterior mediastinal mass using the da Vinci computer enhanced surgical system. Ann Thorac Surg, 2002, 74(4): 1235-1237.
73.	黃佳, 羅清泉, 譚強. 機器人外科手術系統輔助胸腔鏡胸腺瘤切除手術一例. 上海醫學, 2010, 33(11): 1072.
74.	M?ller T, Egberts JH. Robot-assisted thoracic surgery—Areas of application and limitations. Chirurg, 2021, 92(2): 122-127.
75.	Nakamura H, Taniguchi Y. Robot-assisted thoracoscopic surgery: Current status and prospects. Gen Thorac Cardiovasc Surg, 2013, 61(3): 127-132.
76.	Ismail M, Swierzy M, Rückert RI, et al. Robotic thymectomy for myasthenia gravis. Thorac Surg Clin, 2014, 24(2): 189-195.
77.	Goldstein SD, Yang SC. Assessment of robotic thymectomy using the Myasthenia Gravis Foundation of America Guidelines. Ann Thorac Surg, 2010, 89(4): 1080-1085.
78.	Kneuertz PJ, Kamel MK, Stiles BM, et al. Robotic thymectomy is feasible for large thymomas: A propensity-matched comparison. Ann Thorac Surg, 2017, 104(5): 1673-1678.
79.	Fok M, Bashir M, Harky A, et al. Video-assisted thoracoscopic versus robotic-assisted thoracoscopic thymectomy: Systematic review and meta-analysis. Innovations (Phila), 2017, 12(4): 259-264.
80.	Evoli A, Meacci E. An update on thymectomy in myasthenia gravis. Expert Rev Neurother, 2019, 19(9): 823-833.
81.	Keijzers M, de Baets M, Hochstenbag M, et al. Robotic thymectomy in patients with myasthenia gravis: Neurological and surgical outcomes. Eur J Cardiothorac Surg, 2015, 48(1): 40-45.
82.	Li F, Ismail M, Elsner A, et al. Surgical techniques for myasthenia gravis: Robotic-assisted thoracoscopic surgery. Thorac Surg Clin, 2019, 29(2): 177-186.
83.	Mineo TC, Ambrogi V. Surgical techniques for myasthenia gravis: Video-assisted thoracic surgery. Thorac Surg Clin, 2019, 29(2): 165-175.
84.	Buentzel J, Heinz J, Hinterthaner M, et al. Robotic versus thoracoscopic thymectomy: The current evidence. Int J Med Robot, 2017, 13(4): e1847.
85.	王維, 李川, 林琳, 等. 經劍突下達芬奇機器人手術與傳統胸腔鏡手術治療重癥肌無力合并胸腺瘤的對比研究. 中國胸心血管外科臨床雜志, 2020, 27(11): 1287-1291.
86.	孟慶軍, 孔繁義, 宋翔. 經劍突下及肋弓下切口胸腔鏡胸腺切除術的臨床分析. 中國胸心血管外科臨床雜志, 2018, 25(5): 449-452.
87.	Suda T. Subxiphoid thymectomy: Single-port, dual-port, and robot-assisted. J Vis Surg, 2017, 3: 75.
88.	Suda T, Hachimaru A, Tochii D, et al. Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: Initial results. Eur J Cardiothorac Surg, 2016, 49 Suppl 1: i54-i58.
89.	Novellino L, Longoni M, Spinelli L, et al. "Extended" thymectomy, without sternotomy, performed by cervicotomy and thoracoscopic technique in the treatment of myasthenia gravis. Int Surg, 1994, 79(4): 378-381.
90.	Yanagiya M, Hiyama N, Matsumoto J. Dual-scopic robotic thymectomy for a large thymic malignant tumor. J Surg Case Rep, 2021, 2021(6): rjab280.
91.	Deen S, Farivar AS, Louie BE. Thoracic techniques: Robotic thymectomy for thymoma. Indian J Surg Oncol, 2013, 4(2): 132-137.
92.	Cerfolio RJ, Bess KM, Wei B, et al. Incidence, results, and our current intraoperative technique to control major vascular injuries during minimally invasive robotic thoracic surgery. Ann Thorac Surg, 2016, 102(2): 394-399.
93.	張含露, 劉倫旭, 陳龍奇, 等. 機器人輔助經劍突下胸腺(擴大)切除手術的臨床應用. 中國胸心血管外科臨床雜志, 2017, 24(10): 743-747.
94.	余振, 于磊, 楊興國, 等. 重癥肌無力的異位胸腺分布規律研究. 中華胸心血管外科雜志, 2021, 37(5): 278-280.
95.	Jaretzki A, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: Recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Ann Thorac Surg, 2000, 70(1): 327-334.
96.	Zhang H, Zheng Y, Chen LQ, et al. Robotic resection of a thymoma behind the left innominate vein. Interact Cardiovasc Thorac Surg, 2019, 29(5): 813-815.
97.	Hamdi S, Mercier O, Fadel E, et al. Is sacrifying the phrenic nerve during thymoma resection worthwhile? Eur J Cardiothorac Surg, 2014, 45(5): e151-e155.
98.	Yano M, Sasaki H, Moriyama S, et al. Preservation of phrenic nerve involved by stage Ⅲ thymoma. Ann Thorac Surg, 2010, 89(5): 1612-1619.
99.	Kondo K, Monden Y. Lymphogenous and hematogenous metastasis of thymic epithelial tumors. Ann Thorac Surg, 2003, 76(6): 1859-1864.
100.	Weksler B, Pennathur A, Sullivan JL, et al. Resection of thymoma should include nodal sampling. J Thorac Cardiovasc Surg, 2015, 149(3): 737-742.
101.	Weksler B, Holden A, Sullivan JL. Impact of positive nodal metastases in patients with thymic carcinoma and thymic neuroendocrine tumors. J Thorac Oncol, 2015, 10(11): 1642-1647.
102.	Hwang Y, Park IK, Park S, et al. Lymph node dissection in thymic malignancies: Implication of the ITMIG lymph node map, TNM stage classification, and recommendations. J Thorac Oncol, 2016, 11(1): 108-114.
103.	Gu Z, Wei Y, Fu J, et al. Lymph node metastases in thymic malignancies: A Chinese Alliance for Research in Thymomas retrospective database analysis. Interact Cardiovasc Thorac Surg, 2017, 25(3): 455-461.
104.	Fang W, Wang Y, Pang L, et al. Lymph node metastasis in thymic malignancies: A Chinese multicenter prospective observational study. J Thorac Cardiovasc Surg, 2018, 156(2): 824-833.
105.	Hwang Y, Kang CH, Park S, et al. Impact of lymph node dissection on thymic malignancies: Multi-institutional propensity score matched analysis. J Thorac Oncol, 2018, 13(12): 1949-1957.
106.	Kondo K, Van Schil P, Detterbeck FC, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: Proposals for the N and M components for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2014, 9(9 Suppl 2): S81-S87.
107.	Detterbeck FC, Moran C, Huang J, et al. Which way is up? Policies and procedures for surgeons and pathologists regarding resection specimens of thymic malignancy. J Thorac Oncol, 2011, 6(7 Suppl 3): S1730-S1738.
108.	Jiang L, Chen H, Ang K, et al. Management of brachiocephalic vein injury during tubeless subxiphoid thoracoscopic thymectomy. Ann Thorac Surg, 2021, 111(3): e197-e199.
109.	?zkan B, Toker A. Catastrophes during video-assisted thoracoscopic thymus surgery for myasthenia gravis. Interact Cardiovasc Thorac Surg, 2016, 23(3): 450-453.
110.	Rea F, Schiavon M, Marulli G. Robotic thymectomy for myasthenia gravis. Ann Cardiothorac Surg, 2015, 4(6): 558-560.
111.	Venuta F, Rendina EA, Pescarmona EO, et al. Multimodality treatment of thymoma: A prospective study. Ann Thorac Surg, 1997, 64(6): 1585-1591.
112.	蔣耀光, 王如文, 趙云平, 等. 重癥肌無力胸腺切除236例分析. 中國胸心血管外科臨床雜志, 2004, 11(1): 32-34.
113.	劉寶東, 張毅, 蘇雷, 等. 重癥肌無力術后發生肌無力危象的危險因素分析. 中國胸心血管外科臨床雜志, 2020, 27(2): 195-198.
114.	錢昆杰, 張力為, 李德生, 等. 重癥肌無力胸腺切除術后發生肌無力危象危險因素的Meta分析. 中國循證醫學雜志, 2016, 16(7): 788-794.
115.	Leuzzi G, Meacci E, Cusumano G, et al. Thymectomy in myasthenia gravis: Proposal for a predictive score of postoperative myasthenic crisis. Eur J Cardiothorac Surg, 2014, 45(4): e76-e88.
116.	Xue L, Wang L, Dong J, et al. Risk factors of myasthenic crisis after thymectomy for thymoma patients with myasthenia gravis. Eur J Cardiothorac Surg, 2017, 52(4): 692-697.
117.	Zou J, Su C, Lun X, et al. Preoperative anxiety in patients with myasthenia gravis and risk for myasthenic crisis after extended transsternal thymectomy: A CONSORT study. Medicine (Baltimore), 2016, 95(10): e2828.
118.	Huang Y, Su L, Zhang Y, et al. Risk factors for postoperative myasthenic crisis after thymectomy in patients with myasthenia gravis. J Surg Res, 2021, 262: 1-5.
119.	Chigurupati K, Gadhinglajkar S, Sreedhar R, et al. Criteria for postoperative mechanical ventilation after thymectomy in patients with myasthenia gravis: A retrospective analysis. J Cardiothorac Vasc Anesth, 2018, 32(1): 325-330.
120.	Uzawa A, Kuwabara S, Suzuki S, et al. Roles of cytokines and T cells in the pathogenesis of myasthenia gravis. Clin Exp Immunol, 2021, 203(3): 366-374.
121.	Zhao R, Luo S, Zhao C. The role of innate immunity in myasthenia gravis. Autoimmun Rev, 2021, 20(5): 102800.
122.	Howard JF, Vissing J, Gilhus NE, et al. Zilucoplan: An investigational complement C5 inhibitor for the treatment of acetylcholine receptor autoantibody-positive generalized myasthenia gravis. Expert Opin Investig Drugs, 2021, 30(5): 483-493.
123.	Keller CW, Pawlitzki M, Wiendl H, et al. Fc-receptor targeted therapies for the treatment of myasthenia gravis. Int J Mol Sci, 2021, 22(11): 5755.
124.	Sabre L, Punga T, Punga AR. Circulating miRNAs as potential biomarkers in myasthenia gravis: Tools for personalized medicine. Front Immunol, 2020, 11: 213.
125.	Haugh AM, Probasco JC, Johnson DB. Neurologic complications of immune checkpoint inhibitors. Expert Opin Drug Saf, 2020, 19(4): 479-488.
126.	Ozawa Y, Uzawa A, Yasuda M, et al. Long-term outcomes and prognostic factors in generalized myasthenia gravis. J Neurol, 2021, 268(10): 3781-3788.

1. Gilhus NE, Tzartos S, Evoli A, et al. Myasthenia gravis. Nat Rev Dis Primers, 2019, 5(1): 30.
2. Deymeer F. History of myasthenia gravis revisited. Noro Psikiyatr Ars, 2020, 58(2): 154-162.
3. 中國免疫學會神經免疫分會. 中國重癥肌無力診斷和治療指南(2020版). 中國神經免疫學和神經病學雜志 2021, 28(1 ): 1-12.
4. Kaufman AJ, Palatt J, Sivak M, et al. Thymectomy for myasthenia gravis: Complete stable remission and associated prognostic factors in over 1000 cases. Semin Thorac Cardiovasc Surg, 2016, Summer,28(2): 561-568.
5. Remes-Troche JM, Téllez-Zenteno JF, Esta?ol B, et al. Thymectomy in myasthenia gravis: Response, complications, and associated conditions. Arch Med Res, 2002, 33(6): 545-551.
6. Fulghum CB. Cystic tumor of the thymic region and myasthenia gravis; report of a case in which the tumor was removed. Ann Intern Med, 1950, 32(2): 327-335.
7. Blalock A, Mason MF, Morgan HJ, et al. Myasthenia gravis and tumors of the thymic region: Report of a case in which the tumor was removed. Ann Surg, 1939, 110(4): 544-561.
8. Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med, 2016, 375(6): 511-522.
9. Newsom-Davis J, Cutter G, Wolfe GI, et al. Status of the thymectomy trial for nonthymomatous myasthenia gravis patients receiving prednisone. Ann N Y Acad Sci, 2008, 1132: 344-347.
10. Cataneo AJM, Felisberto G, Cataneo DC. Thymectomy in nonthymomatous myasthenia gravis—Systematic review and meta-analysis. Orphanet J Rare Dis, 2018, 13(1): 99.
11. Kerty E, Elsais A, Argov Z, et al. EFNS/ENS guidelines for the treatment of ocular myasthenia. Eur J Neurol, 2014, 21(5): 687-693.
12. Narayanaswami P, Sanders DB, Wolfe G, et al. International consensus guidance for management of myasthenia gravis: 2020 update. Neurology, 2021, 96(3): 114-122.
13. Murai H, Utsugisawa K, Nagane Y, et al. Rationale for the clinical guidelines for myasthenia gravis in Japan. Ann N Y Acad Sci, 2018, 1413(1): 35-40.
14. Sussman J, Farrugia ME, Maddison P, et al. Myasthenia gravis: Association of British Neurologists' management guidelines. Pract Neurol, 2015, 15(3): 199-206.
15. Melzer N, Ruck T, Fuhr P, et al. Clinical features, pathogenesis, and treatment of myasthenia gravis: A supplement to the guidelines of the German Neurological Society. J Neurol, 2016, 263(8): 1473-1494.
16. Osserman KE, Genkins G. Studies in myasthenia gravis: Review of a twenty-year experience in over 1200 patients. Mt Sinai J Med 1971; 38 (6): 497-537.
17. 曾漣乾, 黃壯士, 張斌. 胸腺瘤與胸腺瘤合并重癥肌無力的臨床探討. 中華胸心血管外科雜志, 2003, 19(1): 19-20.
18. 陳向軍, 呂傳真. 重癥肌無力的臨床分型與診斷. 新醫學, 2000, 31(5): 267-268.
19. Cui XZ, Ji XY, Gao F, et al. Evaluation of the new classification and surgical strategy for myasthenia gravis. Am Surg, 2012, 78(12): 1329-1335.
20. Jaretzki A, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: Recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Neurology, 2000, 55(1): 16-23.
21. Meriggioli MN, Sanders DB. Autoimmune myasthenia gravis: Emerging clinical and biological heterogeneity. Lancet Neurol, 2009, 8(5): 475-490.
22. Gilhus NE, Verschuuren JJ. Myasthenia gravis: Subgroup classification and therapeutic strategies. Lancet Neurol, 2015, 14(10): 1023-1036.
23. 陳淵, 張鵬. 重癥肌無力外科治療京津冀專家共識. 天津醫藥, 2020, 48(4): 327-332.
24. Diaz A, Black E, Dunning J. Is thymectomy in non-thymomatous myasthenia gravis of any benefit? Interact Cardiovasc Thorac Surg, 2014, 18(3): 381-389.
25. Marx A, Pfister F, Schalke B, et al. The different roles of the thymus in the pathogenesis of the various myasthenia gravis subtypes. Autoimmun Rev, 2013, 12(9): 875-884.
26. Zhang J, Chen Y, Zhang H, et al. Effects of thymectomy on late-onset non-thymomatous myasthenia gravis: Systematic review and meta-analysis. Orphanet J Rare Dis, 2021, 16(1): 232.
27. Zhang J, Chen Y, Chen J, et al. AChRAb and MuSKAb double-seropositive myasthenia gravis: A distinct subtype? Neurol Sci, 2021, 42(3): 863-869.
28. 中國免疫學會神經免疫學分會, 中華醫學會神經病學分會. 神經免疫學組重癥肌無力診斷和治療中國專家共識. 中國神經免疫學和神經病學雜志, 2012, 19(6): 401-408.
29. Sussman J, Farrugia ME, Maddison P, et al. The Association of British Neurologists' myasthenia gravis guidelines. Ann N Y Acad Sci, 2018, 1412(1): 166-169.
30. O'Connell K, Ramdas S, Palace J. Management of juvenile myasthenia gravis. Front Neurol, 2020, 11: 743.
31. 蔣耀光, 陳建明, 王如文, 等. 單純眼肌型重癥肌無力胸腺切除的適應證探討. 中國胸心血管外科臨床雜志, 1998, 5(1): 9-10.
32. Chu XY, Xue ZQ, Wang RW, et al. Predictors of postoperative myasthenic crisis in patients with myasthenia gravis after thymectomy. Chin Med J (Engl), 2011, 124(8): 1246-1250.
33. Fisher K, Shah V. Pediatric ocular myasthenia gravis. Curr Treat Options Neurol, 2019, 21(10): 46.
34. Marx A, Rüdiger T, R??ner E, et al. Ectopic thymic tissue and ectopic thymic tumors. Pathologe, 2018, 39(5): 390-397.
35. 王如文, 李昆昆, 鄧波, 等. 重癥肌無力危象的防治現狀及展望. 中華胸心血管外科雜志, 2017, 33(3): 129-132.
36. Romi F, Aarli JA, Gilhus NE. Seronegative myasthenia gravis: Disease severity and prognosis. Eur J Neurol, 2005, 12(6): 413-418.
37. Comacchio GM, Marulli G, Mammana M, et al. Surgical decision making: Thymoma and myasthenia gravis. Thorac Surg Clin, 2019, 29(2): 203-213.
38. McInnis MC, Flores EJ, Shepard JA, et al. Pitfalls in the imaging and interpretation of Benign thymic lesions: How thymic MRI can help. AJR Am J Roentgenol, 2016, 206(1): W1-W8.
39. Kim K, Jeong JH, Kim SJ. Diagnostic test accuracy of 18F-FDG PET or PET/CT for characterization of histologic type of thymic epithelial tumor: A meta-analysis. Clin Nucl Med, 2022, 47(1): 36-42.
40. Skeie GO, Apostolski S, Evoli A, et al. Guidelines for treatment of autoimmune neuromuscular transmission disorders. Eur J Neurol, 2010, 17(7): 893-902.
41. Kirschner PA. Alfred Blalock and thymectomy for myasthenia gravis. Ann Thorac Surg, 1987, 43(3): 348-349.
42. Zisimopoulou P, Brenner T, Trakas N, et al. Serological diagnostics in myasthenia gravis based on novel assays and recently identified antigens. Autoimmun Rev, 2013, 12(9): 924-930.
43. Marinkovi? G, Kroon J, Hoogenboezem M, et al. Inhibition of GTPase Rac1 in endothelium by 6-mercaptopurine results in immunosuppression in nonimmune cells: New target for an old drug. J Immunol, 2014, 192(9): 4370-4378.
44. Maddison P, McConville J, Farrugia ME, et al. The use of rituximab in myasthenia gravis and Lambert-Eaton myasthenic syndrome. J Neurol Neurosurg Psychiatry, 2011, 82(6): 671-673.
45. Beecher G, Anderson D, Siddiqi ZA. Rituximab in refractory myasthenia gravis: Extended prospective study results. Muscle Nerve, 2018, 58(3): 452-455.
46. Tada M, Shimohata T, Tada M, et al. Long-term therapeutic efficacy and safety of low-dose tacrolimus (FK506) for myasthenia gravis. J Neurol Sci, 2006, 247(1): 17-20.
47. Cortese I, Chaudhry V, So YT, et al. Evidence-based guideline update: Plasmapheresis in neurologic disorders: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 2011, 76(3): 294-300.
48. Seyhanli A, Yavuz B, Selimoglu I, et al. Therapeutic plasma exchange in neurological diseases: Eleven years experience at a tertiary care center in Turkey. Ther Apher Dial, 2021. [Epub ahead of print].
49. 中國醫師協會醫學機器人醫師分會胸外科專業委員會籌備組, 譚群友, 陶紹霖, 等. 機器人輔助縱隔腫瘤手術中國專家共識 (2019版). 中國胸心血管外科臨床雜志, 2020, 27(2): 117-125.
50. Campos JH. An update on robotic thoracic surgery and anesthesia. Curr Opin Anaesthesiol, 2010, 23(1): 1-6.
51. Yamashita A, Takenami T, Kawabata M, et al. Steroid-induced rapid recovery from respiratory dysfunction in a patient with myasthenia gravis after spinal anesthesia. J Anesth, 2021, 35(1): 142-144.
52. Kirschner PA, Osserman KE, Kark AE. Studies in myasthenia gravis. Transcervical total thymectomy. JAMA, 1969, 209(6): 906-910.
53. Cooper JD, Al-Jilaihawa AN, Pearson FG, et al. An improved technique to facilitate transcervical thymectomy for myasthenia gravis. Ann Thorac Surg, 1988, 45(3): 242-247.
54. 宋楠, 姜格寧, 陳曉峰, 等. 經頸胸腺及胸腺瘤切除術21例. 中國胸心血管外科臨床雜志, 2011, 18(6): 578-579.
55. de Perrot M, Bril V, McRae K, et al. Impact of minimally invasive trans-cervical thymectomy on outcome in patients with myasthenia gravis. Eur J Cardiothorac Surg, 2003, 24(5): 677-683.
56. Wright GM, Barnett S, Clarke CP. Video-assisted thoracoscopic thymectomy for myasthenia gravis. Intern Med J, 2002, 32(8): 367-371.
57. Zieliński M, Kuzdza? J, Szlubowski A, et al. Transcervical-subxiphoid-videothoracoscopic "maximal" thymectomy-operative technique and early results. Ann Thorac Surg, 2004, 78(2): 404-409.
58. Mantegazza R, Baggi F, Bernasconi P, et al. Video-assisted thoracoscopic extended thymectomy and extended transsternal thymectomy (T-3b) in non-thymomatous myasthenia gravis patients: Remission after 6 years of follow-up. J Neurol Sci, 2003, 212(1-2): 31-36.
59. Masaoka A, Yamakawa Y, Niwa H, et al. Extended thymectomy for myasthenia gravis patients: A 20-year review. Ann Thorac Surg, 1996, 62(3): 853-859.
60. 張清勇, 蘇彥河, 楊鯤鵬, 等. 胸骨橫斷第二肋間切口胸腺切除治療重癥肌無力365例體會. 鄭州大學學報(醫學版), 2005, 40(1): 15-16.
61. Jaretzki A, 3rd, Penn AS, Younger DS, et al. "Maximal" thymectomy for myasthenia gravis. Results. J Thorac Cardiovasc Surg, 1988, 95(5): 747-757.
62. Bulkley GB, Bass KN, Stephenson GR, et al. Extended cervicomediastinal thymectomy in the integrated management of myasthenia gravis. Ann Surg, 1997, 226(3): 324-334.
63. Friedant AJ, Handorf EA, Su S, et al. Minimally invasive versus open thymectomy for thymic malignancies: Systematic review and meta-analysis. J Thorac Oncol, 2016, 11(1): 30-38.
64. Qi K, Wang B, Wang B, et al. Video-assisted thoracoscopic surgery thymectomy versus open thymectomy in patients with myasthenia gravis: A meta-analysis. Acta Chir Belg, 2016, 116(5): 282-288.
65. O'Sullivan KE, Kreaden US, Hebert AE, et al. A systematic review and meta-analysis of robotic versus open and video-assisted thoracoscopic surgery approaches for lobectomy. Interact Cardiovasc Thorac Surg, 2019, 28(4): 526-534.
66. Melfi FM, Fanucchi O, Mussi A. Minimally invasive mediastinal surgery. Ann Cardiothorac Surg, 2016, 5(1): 10-17.
67. Kaba E, Cosgun T, Ayalp K, et al. Robotic thymectomy for myasthenia gravis. Ann Cardiothorac Surg, 2019, 8(2): 288-291.
68. Romano G, Zirafa CC, Ceccarelli I, et al. Robotic thymectomy for thymoma in patients with myasthenia gravis: Neurological and oncological outcomes. Eur J Cardiothorac Surg, 2021, 60(4): 890-895.
69. Castle SL, Kernstine KH. Robotic-assisted thymectomy. Semin Thorac Cardiovasc Surg, Winter 2008, 20(4): 326-331.
70. Sugarbaker DJ. Thoracoscopy in the management of anterior mediastinal masses. Ann Thorac Surg, 1993, 56(3): 653-656.
71. Coosemans W, Lerut TE, Van Raemdonck DE. Thoracoscopic surgery: The Belgian experience. Ann Thorac Surg, 1993, 56(3): 721-730.
72. Yoshino I, Hashizume M, Shimada M, et al. Video-assisted thoracoscopic extirpation of a posterior mediastinal mass using the da Vinci computer enhanced surgical system. Ann Thorac Surg, 2002, 74(4): 1235-1237.
73. 黃佳, 羅清泉, 譚強. 機器人外科手術系統輔助胸腔鏡胸腺瘤切除手術一例. 上海醫學, 2010, 33(11): 1072.
74. M?ller T, Egberts JH. Robot-assisted thoracic surgery—Areas of application and limitations. Chirurg, 2021, 92(2): 122-127.
75. Nakamura H, Taniguchi Y. Robot-assisted thoracoscopic surgery: Current status and prospects. Gen Thorac Cardiovasc Surg, 2013, 61(3): 127-132.
76. Ismail M, Swierzy M, Rückert RI, et al. Robotic thymectomy for myasthenia gravis. Thorac Surg Clin, 2014, 24(2): 189-195.
77. Goldstein SD, Yang SC. Assessment of robotic thymectomy using the Myasthenia Gravis Foundation of America Guidelines. Ann Thorac Surg, 2010, 89(4): 1080-1085.
78. Kneuertz PJ, Kamel MK, Stiles BM, et al. Robotic thymectomy is feasible for large thymomas: A propensity-matched comparison. Ann Thorac Surg, 2017, 104(5): 1673-1678.
79. Fok M, Bashir M, Harky A, et al. Video-assisted thoracoscopic versus robotic-assisted thoracoscopic thymectomy: Systematic review and meta-analysis. Innovations (Phila), 2017, 12(4): 259-264.
80. Evoli A, Meacci E. An update on thymectomy in myasthenia gravis. Expert Rev Neurother, 2019, 19(9): 823-833.
81. Keijzers M, de Baets M, Hochstenbag M, et al. Robotic thymectomy in patients with myasthenia gravis: Neurological and surgical outcomes. Eur J Cardiothorac Surg, 2015, 48(1): 40-45.
82. Li F, Ismail M, Elsner A, et al. Surgical techniques for myasthenia gravis: Robotic-assisted thoracoscopic surgery. Thorac Surg Clin, 2019, 29(2): 177-186.
83. Mineo TC, Ambrogi V. Surgical techniques for myasthenia gravis: Video-assisted thoracic surgery. Thorac Surg Clin, 2019, 29(2): 165-175.
84. Buentzel J, Heinz J, Hinterthaner M, et al. Robotic versus thoracoscopic thymectomy: The current evidence. Int J Med Robot, 2017, 13(4): e1847.
85. 王維, 李川, 林琳, 等. 經劍突下達芬奇機器人手術與傳統胸腔鏡手術治療重癥肌無力合并胸腺瘤的對比研究. 中國胸心血管外科臨床雜志, 2020, 27(11): 1287-1291.
86. 孟慶軍, 孔繁義, 宋翔. 經劍突下及肋弓下切口胸腔鏡胸腺切除術的臨床分析. 中國胸心血管外科臨床雜志, 2018, 25(5): 449-452.
87. Suda T. Subxiphoid thymectomy: Single-port, dual-port, and robot-assisted. J Vis Surg, 2017, 3: 75.
88. Suda T, Hachimaru A, Tochii D, et al. Video-assisted thoracoscopic thymectomy versus subxiphoid single-port thymectomy: Initial results. Eur J Cardiothorac Surg, 2016, 49 Suppl 1: i54-i58.
89. Novellino L, Longoni M, Spinelli L, et al. "Extended" thymectomy, without sternotomy, performed by cervicotomy and thoracoscopic technique in the treatment of myasthenia gravis. Int Surg, 1994, 79(4): 378-381.
90. Yanagiya M, Hiyama N, Matsumoto J. Dual-scopic robotic thymectomy for a large thymic malignant tumor. J Surg Case Rep, 2021, 2021(6): rjab280.
91. Deen S, Farivar AS, Louie BE. Thoracic techniques: Robotic thymectomy for thymoma. Indian J Surg Oncol, 2013, 4(2): 132-137.
92. Cerfolio RJ, Bess KM, Wei B, et al. Incidence, results, and our current intraoperative technique to control major vascular injuries during minimally invasive robotic thoracic surgery. Ann Thorac Surg, 2016, 102(2): 394-399.
93. 張含露, 劉倫旭, 陳龍奇, 等. 機器人輔助經劍突下胸腺(擴大)切除手術的臨床應用. 中國胸心血管外科臨床雜志, 2017, 24(10): 743-747.
94. 余振, 于磊, 楊興國, 等. 重癥肌無力的異位胸腺分布規律研究. 中華胸心血管外科雜志, 2021, 37(5): 278-280.
95. Jaretzki A, Barohn RJ, Ernstoff RM, et al. Myasthenia gravis: Recommendations for clinical research standards. Task Force of the Medical Scientific Advisory Board of the Myasthenia Gravis Foundation of America. Ann Thorac Surg, 2000, 70(1): 327-334.
96. Zhang H, Zheng Y, Chen LQ, et al. Robotic resection of a thymoma behind the left innominate vein. Interact Cardiovasc Thorac Surg, 2019, 29(5): 813-815.
97. Hamdi S, Mercier O, Fadel E, et al. Is sacrifying the phrenic nerve during thymoma resection worthwhile? Eur J Cardiothorac Surg, 2014, 45(5): e151-e155.
98. Yano M, Sasaki H, Moriyama S, et al. Preservation of phrenic nerve involved by stage Ⅲ thymoma. Ann Thorac Surg, 2010, 89(5): 1612-1619.
99. Kondo K, Monden Y. Lymphogenous and hematogenous metastasis of thymic epithelial tumors. Ann Thorac Surg, 2003, 76(6): 1859-1864.
100. Weksler B, Pennathur A, Sullivan JL, et al. Resection of thymoma should include nodal sampling. J Thorac Cardiovasc Surg, 2015, 149(3): 737-742.
101. Weksler B, Holden A, Sullivan JL. Impact of positive nodal metastases in patients with thymic carcinoma and thymic neuroendocrine tumors. J Thorac Oncol, 2015, 10(11): 1642-1647.
102. Hwang Y, Park IK, Park S, et al. Lymph node dissection in thymic malignancies: Implication of the ITMIG lymph node map, TNM stage classification, and recommendations. J Thorac Oncol, 2016, 11(1): 108-114.
103. Gu Z, Wei Y, Fu J, et al. Lymph node metastases in thymic malignancies: A Chinese Alliance for Research in Thymomas retrospective database analysis. Interact Cardiovasc Thorac Surg, 2017, 25(3): 455-461.
104. Fang W, Wang Y, Pang L, et al. Lymph node metastasis in thymic malignancies: A Chinese multicenter prospective observational study. J Thorac Cardiovasc Surg, 2018, 156(2): 824-833.
105. Hwang Y, Kang CH, Park S, et al. Impact of lymph node dissection on thymic malignancies: Multi-institutional propensity score matched analysis. J Thorac Oncol, 2018, 13(12): 1949-1957.
106. Kondo K, Van Schil P, Detterbeck FC, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: Proposals for the N and M components for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2014, 9(9 Suppl 2): S81-S87.
107. Detterbeck FC, Moran C, Huang J, et al. Which way is up? Policies and procedures for surgeons and pathologists regarding resection specimens of thymic malignancy. J Thorac Oncol, 2011, 6(7 Suppl 3): S1730-S1738.
108. Jiang L, Chen H, Ang K, et al. Management of brachiocephalic vein injury during tubeless subxiphoid thoracoscopic thymectomy. Ann Thorac Surg, 2021, 111(3): e197-e199.
109. ?zkan B, Toker A. Catastrophes during video-assisted thoracoscopic thymus surgery for myasthenia gravis. Interact Cardiovasc Thorac Surg, 2016, 23(3): 450-453.
110. Rea F, Schiavon M, Marulli G. Robotic thymectomy for myasthenia gravis. Ann Cardiothorac Surg, 2015, 4(6): 558-560.
111. Venuta F, Rendina EA, Pescarmona EO, et al. Multimodality treatment of thymoma: A prospective study. Ann Thorac Surg, 1997, 64(6): 1585-1591.
112. 蔣耀光, 王如文, 趙云平, 等. 重癥肌無力胸腺切除236例分析. 中國胸心血管外科臨床雜志, 2004, 11(1): 32-34.
113. 劉寶東, 張毅, 蘇雷, 等. 重癥肌無力術后發生肌無力危象的危險因素分析. 中國胸心血管外科臨床雜志, 2020, 27(2): 195-198.
114. 錢昆杰, 張力為, 李德生, 等. 重癥肌無力胸腺切除術后發生肌無力危象危險因素的Meta分析. 中國循證醫學雜志, 2016, 16(7): 788-794.
115. Leuzzi G, Meacci E, Cusumano G, et al. Thymectomy in myasthenia gravis: Proposal for a predictive score of postoperative myasthenic crisis. Eur J Cardiothorac Surg, 2014, 45(4): e76-e88.
116. Xue L, Wang L, Dong J, et al. Risk factors of myasthenic crisis after thymectomy for thymoma patients with myasthenia gravis. Eur J Cardiothorac Surg, 2017, 52(4): 692-697.
117. Zou J, Su C, Lun X, et al. Preoperative anxiety in patients with myasthenia gravis and risk for myasthenic crisis after extended transsternal thymectomy: A CONSORT study. Medicine (Baltimore), 2016, 95(10): e2828.
118. Huang Y, Su L, Zhang Y, et al. Risk factors for postoperative myasthenic crisis after thymectomy in patients with myasthenia gravis. J Surg Res, 2021, 262: 1-5.
119. Chigurupati K, Gadhinglajkar S, Sreedhar R, et al. Criteria for postoperative mechanical ventilation after thymectomy in patients with myasthenia gravis: A retrospective analysis. J Cardiothorac Vasc Anesth, 2018, 32(1): 325-330.
120. Uzawa A, Kuwabara S, Suzuki S, et al. Roles of cytokines and T cells in the pathogenesis of myasthenia gravis. Clin Exp Immunol, 2021, 203(3): 366-374.
121. Zhao R, Luo S, Zhao C. The role of innate immunity in myasthenia gravis. Autoimmun Rev, 2021, 20(5): 102800.
122. Howard JF, Vissing J, Gilhus NE, et al. Zilucoplan: An investigational complement C5 inhibitor for the treatment of acetylcholine receptor autoantibody-positive generalized myasthenia gravis. Expert Opin Investig Drugs, 2021, 30(5): 483-493.
123. Keller CW, Pawlitzki M, Wiendl H, et al. Fc-receptor targeted therapies for the treatment of myasthenia gravis. Int J Mol Sci, 2021, 22(11): 5755.
124. Sabre L, Punga T, Punga AR. Circulating miRNAs as potential biomarkers in myasthenia gravis: Tools for personalized medicine. Front Immunol, 2020, 11: 213.
125. Haugh AM, Probasco JC, Johnson DB. Neurologic complications of immune checkpoint inhibitors. Expert Opin Drug Saf, 2020, 19(4): 479-488.
126. Ozawa Y, Uzawa A, Yasuda M, et al. Long-term outcomes and prognostic factors in generalized myasthenia gravis. J Neurol, 2021, 268(10): 3781-3788.

Next Article
Insights into clinical studies in cardiac surgery from the American Heart Association’s Scientific Sessions 2021: Part two

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Chinese clinical expert consensus on surgical treatment of myasthenia gravis

Abstract Full text Figures/Tables Video References Cited by

Next Article

Format

Content