重症肌无力合并甲状腺疾病的外科治疗

Surgical treatment of myasthenia gravis associated with thyroid diseases

目的探讨重症肌无力(MG)合并甲状腺疾病胸腺切除术的疗效。方法MG合并甲状腺疾病23例中,合并甲状腺功能亢进症(HT)19例,甲状腺功能减退2例,桥本氏甲状腺炎2例。23例患者均采用胸腺切除术,单纯胸腺切除术者16例,同期行胸腺切除加甲状腺次全切除术2例,胸腺切除术后二期行甲状腺次全切除术5例。结果全组无手术死亡,无MG危象的发生;发生肺不张2例。随访(8.76±5.68)年,术后MG完全缓解率为69.6%(16/23)。5例HT于甲状腺切除术后完全停用抗甲状腺类药物;12例HT未切除甲状腺患者于MG术后8～12个月停服抗HT药,5例停药1年后因血清中游离三碘甲状腺原氨酸和游离甲状腺素升高而需再次服用丙基硫氧嘧啶(100 mg/d)治疗;2例甲状腺功能减退者术后8个月均停服了甲状腺素片。结论全胸腺切除治疗MG合并甲状腺疾病的疗效满意,是否同时行甲状腺次全切除术要视患者自身情况来决定。

Objective To summarize the curative outcomes of thymectomy in the patients with myasthenia gravis（MG） associated with thyroid diseases.Methods Thymectomy was carried out in 23 patients（8 males and 15 females,aged from 18 to 42 years old） with MG associated with thyroid diseases including hyperthyroidism（HT） in 19 patients（82.6%）,hypothyroidism in 2（8.7%）,Hashimoto′s thyroiditis in 2（8.7%）.Sixteen patients merely underwent thymectomy,2 with thyroiditis underwent thymectomy and subtotal thyroidectomy simultaneously,and 5 with HT underwent thymectomy followed by second-stage subtotal thyroidectomy.Results No operative death and no MG and HT crisis happened in this group.The postoperative course of all patients was uneventful.Two patients had atelectasis.During the 6 months to 20 years follow-up,16 out of 23 patients obtained MG remission,7 patients still required anticholinesterase（pyridostigmine 60～180mg/d） and obviously improved in MG,5 MG with HT required no anti-hyperthyroid medication at all postoperationly,12 cases with HT without thyroidectomy stopped anti-hyperthyroid medication 8 to 12 month after operation.Because free triiodothyronine and free thyroxin in blood were increased after one year of discontinued anti-hyperthyroid medication,5 of 12 cases required propylthiouracil（100mg/d）.Two cases associated with hypothyroidism stopped thyroxin medication 8 month after operation.Conclusion Complete thymectomy is a safe and effective alterative for patients with MG associated with thyroid diseases.Simultaneously subtotal thyroidectomy shoud be decided individually.