40例胸腺肿瘤合并重症肌无力的手术治疗

Surgical Treatment for Patients with Thymoma Associated with Myasthenia Gravis (Report of 40 Cases)

报告４０例胸腺肿瘤合并重症肌无力（ＭＧ）的手术治疗效果。本组包括完全切除肿瘤和胸腺２６例，次全切除肿瘤１０例，组织活检４例。结果手术死亡１例（２．５％），术后１年内死亡８例（２０．５％）。３１例术后随访３～１２年，５年生存率为６１．３％，１０年生存率２７．７％；其中非浸润型胸腺瘤分别为７６．９％和３０．０％，浸润型胸腺瘤则为５０．０％和２５．０％。ＭＧ术后缓解改善率为８０．６％，术后肌无力危象发生率为４０．０％，抢救成功率为９３．８％，结论显示手术治疗胸腺肿瘤合并ＭＧ，如严格掌握手术指征，可获得较好的疗效和预后。

Aim:To evaluate the outcome of surgical treatment for myasthenia gravis. Clinical material and method:Forty patients with thymoma associated with myasthenia gravis were treated surgically.There were 26 males and 14 females with a mean age of 44.2 years.According to Osserman classification,stage IIa was in 6 patients,stage IIb in 14,stage III in 5 and stage IV in 15 patients.Surgical procedures included complete thymectomy in 26 patients,partial thymectomy in 10 and simple biopsy in 4 patients.Result:There was one operative death with a hospital mortality rate of 2.5%.The cause of death was respiratory insufficiency.Late death occurred in 8 patients.Overall five and tenyear survival rates were 61.3% and 27.7%,respectively.The 5 and 10year survival rates were 76.9% and 30.0% for noninfiltrated tumor and 50.0% and 25.0% for infiltrated tumor.40.0% of patients had complication of respiratory insufficiency after surgery.Complete improvement was achieved in 15 patients (48.4%),partial improvement in 10,no improvement in 4 and worse in 2. Conclusion:Thymectomy is the treatment of choice for thymoma with generalized myasthenia gravis.The operation offers a satisfactory percentage of clinical improvement with low mortality and morbidity rates.The surgical outcome is related to clinical staging of myasthenia gravis and perioperative management.