重症肌无力合并胸腺瘤的手术治疗

Surgical Treatment of Myasthenia Gravis Associated with Thymoma

目的总结重症肌无力合并胸腺瘤的围手术期处理方法及手术治疗效果.方法分析1994年9月～2004年1月接受手术治疗的42例重症肌无力合并胸腺瘤患者的临床资料.按改良Osserman标准分为Ⅰ型11例、Ⅱa型9例、Ⅱb型19例、Ⅲ型3例.随访结果按完全缓解、部分缓解、无效进行评价.结果 42例无手术死亡,4例术后早期发生MG危象,经气管切开、辅助呼吸等抢救治疗痊愈.随访40例,手术后重症肌无力症状完全缓解18例,部分缓解率20例,无效2例.1例术后1年死于肿瘤复发并肺转移.结论完善围术期管理,减少MG危象的发生,手术治疗重症肌无力合并胸腺瘤可获得良好的疗效.

Objective To summarize the therapeutic effect of surgical treatment and the perioperative management of myasthenia gravis associated with thymoma. Methods The data of 42 cases of myasthenia gravis associated with thymoma which underwent surgical treatment from september, 1994 to January,2004 were analyzed. Based on the modified Osserman classification, there were 9 cases of type Ⅰ, 17 cases of type Ⅱ a, 12 cases of type Ⅱ b,and 3 cases of type Ⅲ disease. The therapeutic effect of the patients at a follow-up visit was evaluated as remission,partial remission or no change. Results There was no operation-related mortality. Four cases suffered from crisis of myasthenia gravis at earlier period after operation and were cured successfully. 40 cases were followed up. Complete remission of MG was achieved in 18 case.s, partial remission was seen in 20 cases, no improvement was happened in 2 cases. 1 patient died of tumor recurrence and lung metastases one year after operation. Conclusion Satisfactory therapeutic effect can be achieved with surgical treatment for myasthenia gravis associated with thymoma. Perioperative management is very important to avoid crisis of mvasthenia eravis.