合并胸腺瘤的重症肌无力患者胸腺切除术临床观察

The Clinical Analysis of Thymectomy for Myasthenia Gravis with Thymoma

目的:观察重症肌无力合并胸腺瘤的手术治疗的近期疗效及危象发生的情况,探讨近期疗效和危象的相关因素。方法:1993年1月至2010年1月手术治疗重症肌无力(my asthenia graris,MG)63例,其中58例合并胸腺瘤。肌无力按改良Osserman分型,Ⅰ型15例,Ⅱa型20例,Ⅱb型12例,Ⅲ型9例,Ⅳ型2例。Masaoka分期:Ⅰ期11例,Ⅱ期27例。Ⅲ期20例,Ⅳ期5例。对术后近期疗效和危象发生情况进行回顾性分析。结果:手术后缓解31例(53.45%),无效6例(10.34%),恶化8例(13.79%),危象15例(25.86%)。MG合并胸腺瘤者,MGII型及以上者是术后发生危象的高危人群。Ⅰ型与Ⅱ型及以上者术后近期的危象发生率差异有统计学意义(P<0.05)。Ⅰ期与Ⅱ期及以上胸腺瘤者术后近期的危象发生率差异无统计学意义(P>0.05)。结论:MG合并胸腺瘤的患者术后危象的发生率明显增加,MG Ⅱ型及以上型术后更容易发生危象,危象的发生与胸腺瘤的病理分期无相关性。

Objective： To observe the short-term outcome and crisis onset after surgical treatment for myasthenia gravis （MG） patients with thymoma and analyze the relevant factors. Methods： 63 patients with MG were treated surgically from Jan. 1993 to Jan. 2010 including 58 patients who were combined with thymoma. MG was classified according to the modified Osserman classification ： type Ⅰ （ n = 15）, type Ⅱa （ n = 20）, type Ⅱb （ n = 12）, type Ⅲ （ n = 9） and type Ⅳ （ n = 2）. There were 11 cases in stage Ⅰ, 27 cases in stage Ⅱ, 20 cases in stage Ⅲ and 5 cases in stage IV according to the Masaoka staging method. The short-term outcome and crisis onset after surgical treatment were analyzed retrospectively. Results： After operation, symptoms improved in 31 cases （53.45%） , didn＇ t change in 6 cases （ 10. 34% ） ,deteriorated in 8 cases（ 13.79% ） and got crisis onset in 15 cases（25.86% ）. Patients with thymoma , MG Ⅱ and the above type of MG were at high-risk of crisis onset after operation. The incidence of crsis in type Ⅰ group was significantly higher than that of type Ⅱ or above after operation（P 〈 0. 05 ）. There was no statistical difference of postoperative short-term incidence of crsis between stage Ⅰ and stage Ⅱ and above （P 〉 0. 05 ）. Conclusion： The risk of crsis onset after operation significantly rises in myasthenia gavis patients with thymoma. Crsis is inclined to occur in MG Ⅱ and above type. The crisis onset is independent to pathological staging of thymoma.