65例胸腺瘤伴重症肌无力患者手术治疗及其预后因素分析

Surgical Treatment for 65 Cases Thymoma with Myasthenia Gravis and Evaluation of Prognostic Factors

目的:观察恶性胸腺瘤伴重症肌无力患者的临床疗效及预后影响因素。方法:对65例恶性胸腺瘤伴重症肌无力患者进行手术治疗并辅以放疗,并按不同术式、Masaoka外科病理分期、L/B病理分型比较。结果:接受根治性手术,Masaoka外科病理分期较早的患者5、10年生存率较高(P<0.05),且前者肌无力症状改善情况亦较好(P<0.05)。不同病理(L/B)类型患者间5、10年生存率及肌无力症状改善无明显差别。结论:恶性胸腺瘤伴重症肌无力患者早期手术并辅以放疗可改善肌无力症状提高生存率;Masaoka外科病理分期和预后密切相关;L/B病理分型和重症肌无力症状的改善及预后无明显相关性。

Aim： To observe the clinical outcome of surgical treatment for malignant thymoma with myasthenia gravis （MG）, and evaluate the prognostic factors. Methods：All patients （65 cases） were operated on followed by radiotherapy, and classified to groups according to Masaoka staging, L/B pathology, and difference of the operation given. Results： Patients with early Masaoka stage and who received radical resection of thymoma had higher 5 and 10 year survival rate （ P 〈 0.05 ） . Besides, the symptoms of myasthenia gravis were better improved （ P 〈 0.05 ）. The difference of L/B pathology was not related to 5 and 10 year survival and symptom improvement. Conclusion： Survival is enhanced for patients with malignant thymoma and MG when both surgical and radiotherapy intervention are given as early as possible. The Masaoka staging is closely related to the prognosis, whereas L/B pathology is not.