单纯眼肌型重症肌无力胸腺切除的适应证探讨

Indication of Thymectomy for Purely Ocular Myasthenia Gravis

目的许多学者对单纯眼肌型重症肌无力（ＰＯＭＧ）不主张手术治疗，为此，探讨ＰＯＭＧ胸腺切除的适应证。方法回顾性分析了１９８０～１９９６年１０月期间所行胸腺切除治疗ＰＯＭＧ２３例。结果２３例ＰＯＭＧ占所有重症肌无力１１７例的１７．９％，术后１例病理证实为胸腺瘤；随访１年有效率为９５．７％，１～３年８８．２％，３～５年９０．９％，超过５年为８７．５％。单纯眼肌型重症肌无力多见于儿童，合并胸腺瘤甚为罕见。结论单纯眼肌型病例行胸腺切除应严格控制，特别是儿童，只有症状严重而长时间对抗胆碱酯酶药物反应不佳或疑有胸腺瘤时才施行手术。

Objective For purely ocular myasthenia gravis (POMG),many authors do not advocate surgical treatment.The goal of this paper is to study the indication of thymectomy for patients with POMG. Methods Retrospective analysis of 23 patients with POMG who underwent thymectomy between 1980 and October 1996 in our department. Results Of the 23 cases occounted for 17.9% in 117 cases of MG,only one case was thymoma proved by pathology after operation.The effective rate in 1 year was 95.7%(22/23),in 1-3 years was 88.2%(15/17),in 3-5 years was 90.9%(10/11) and over 5 years was 87.5%(7/8).POMG was very common in children (10/23) and with thymoma was quite rare(1/23).About 20% of cases of ocular MG underwent spontaneous remission in literatures. Conclusion The indication of thymectomy for purely ocular MG should be strictly controlled. In prepuberal children thymectomy is only performed when the symptoms remain severe with no response to long term anticholinesterase therapy or when thymoma is suspected.