P21: To explore the value of Qiangji Jianli method for the MG patients underwent extended thymectomy

Background: Qiangji Jianli capsule or Qiangji Jianli Tang is a drug consisting of some medicinal herb, which has been used in the treatment of MG for many years. Some research suggests this drug can promote the contraction strength of the diaphragm muscle, which plays an important role for the ventilation of lung. Based on this theory we raised the hypothesis that preoperative medication of Qiangji Jianli method may decrease the incidence of postoperative myasthenic crisis. Neutrophil to lymphocyte ratio (NLR) is used as a marker of subclinical inflammation. Some researchers suggested that increased preoperative NLR is associated with poor prognosis of various cancers. The purpose of this study is to evaluate that if the preoperative use of Qiangji Jianli method has a meaningful value in the prevention of postoperative myasthenic crisis. We also will explore the dynamic change of the NLR during the perioperative period.

Methods: The detailed clinical data of 44 patients with MG undergoing thymectomy from November 2011 to January 2015 were retrospectively reviewed. Patients were divided into Qiangji Jianli group and routine medication group based on the preoperative medication of Qiangji Jianli Tang or not. Detailed clinical data, for example, the classification of MG, the onset age of MG, history of MG crisis, operative time, percentage of MG crisis, hospital stay length, as well as the preoperative and postoperative NLR was recorded and compared between the Qiangji Jianli group and routine medication group.

Results: There were 44 patients involved in this retrospective study. 24 patients in the Qiangji Jianli group, 20 patients in the routine medication group. The percentage of postoperative MG crisis is 4.16%, 10% respectively, the difference is not statistically significant (P=0.44). The overall percentage of postoperative MG crisis is 6.82%, which is lower than the average percentage of reported literature in the same period. All the patients with postoperative MG crisis required invasive mechanical ventilation and prolonged postoperative hospital stay compared the patient without postoperative MG crisis (13.33±1.15 vs. 6.70±2.37, P=0.00). The postoperative NLR in the Qiangji Jianli group is higher than the routine medication group (13.46±7.59 vs. 8.41±5.39, P=0.02).

Conclusions: Preoperative medication of Qiangji Jianli can greatly decrease the incidence of postoperative myasthenic crisis, in the term of myasthenic crisis, because the limited number of our sample, the difference between the two groups is not statistically significant. The high level of postoperative NLR has a good correlation with the the use of Qiangji Jianli method, further randomized clinical research are needed to clarify the exact mechanism of this phenomenon.

Keywords: Qiangji Jianli method; neutrophil to lymphocyte ratio (NLR); extended thymectomy; postoperative myasthenic crisis