胸腺切除治疗重症肌无力疗效观察

Clinical Features of Myasthenia Gravis and Thymectomy Treatment

３８例中老年各型重症肌无力患者（ＭＧ）行胸腺切除术治疗。病理结果显示，胸腺异常率为９４．７％（３６／３８），并发胸腺瘤占６５．８％（２５／３８），其中恶性胸腺瘤占胸腺瘤的６４．０％（１６／１５）。其他胸腺异常为２８．９％（１１／３８），正常胸腺２例。３８例中４７．４％（１８／３８）术后发生ＭＧ危象，以Ⅱｂ和Ⅲ型病例及合并有胸腺瘤者多见。围手术期病死率为１０．５％（４／３８）。术后随访３４例，症状缓解２３．５％（８／３４），改善４１．２％（１４／３４），无变化为５．９％（２／３４），与本病有关的病死率为２３．５％（８／３４），另２例死于非ＭＧ疾病。中、老年性ＭＧ患者病情较重，多合并有胸腺瘤，手术前、后易发生ＭＧ危象，缓解改善率低，围手术期或离院后病死率均较高。

Thirty-eight middle-aged and elderly patients with myathenia gravis(MG)were treated with thymectomy during Mar. 1986 to Oct. 1996. On pathologic examination, the incidence of thymic abnormality was 94.7%, 65 .8% were combined with thymoma and 64. 0 % were malignant. MG; crisis occurred in 47. 4 % patients after operation, mainly in patients of Ⅱb, Ⅲ or with thymoma. Four patients died in perioperation period. After operation,34 patients were followed up for 6 months to 11 years. The remission rate was 23. 5 %, improvement 41. 2 %, 5. 9 % remained stable, and the mortality associated with this disease was 23. 5 %. The systemic type MG was common in the middle-aged and elderly patients, was serious and often combined with thymoma. Crisis occurred in perioperation period more easily. The remission time was short, the improvement rate was low and mortality high.