胸腺切除治疗重症肌无力临床探讨

CLINIC RESEARCH FOR THYMECTOMY IN THE TREATMENT OF MYASTHENIA GRAVIS

自1966年3月～1994年10月，采用胸腺切除术治疗各型重症肌无力122例。所有病例的胸腺均经病理检查，胸腺异常为95．1％，其中胸腺瘤占37．7％，恶性胸腺癌占胸腺瘤的67．4％。术后47．5％的病例发生了重症肌无力危象，该危象多见于ⅡB和Ⅲ型病例。6．5％的病例在院死亡。术后对106例进行了6个月至28年随访，症状缓解和改善者占68．9％，无变化者占8．5％，术后离院与本病有关死亡者为17．9％。该文认为，病情严重ⅡB、Ⅲ型病例胸腺切除早期行气管切开术，酌情使用人工呼吸机，是预防和治疗重症肌无力危象的重要方法，有助于降低围手术期死亡率。

Thymectomy was performed in 122 patients with myasthenia gravis (MG) from March,1966 to Oct., 1994. All removed thymic tissues were examined by the pathologists in our hospital. Abnormal rate of these thymic glands was 95.1% and 37.7% for thymoma, of which malignant thymoma was 67.4%. MG crises occurered in 47.5% patients after the operation. The MG crises were found more in the type Ⅱ B and Ⅲ than in other types. 8 patients died postoperatively and the mortality was 6.5% of in-patients. 106 patients were followed up, the period ranging from 6 months to 28 years after discharged from hospital. The patients whose MG symptoms were relieved and improved were 68.9%; the patients whose condition had no change was 8. 5 %, and 17. 9% died of the disease. We thought that it was necessary for servere cases of type ⅡB and Ⅲ to be given tracheotomy with thymectomy in the early stage of the operation,and ventilatory support be available according to the postoperative conditions. This was an effective method to prevent and treat MG crises, and it could lower the mortality of perioperation.