Clinical study of surgery for patients with myasthenia gravis and hyperthyroidism

目的 :探讨重症肌无力 (MG)并发甲状腺机能亢进 (甲亢 )病人的临床治疗特点和外科治疗的效果。方法 :对 1 1例患 MG并发甲亢病人分别行甲状腺次全切除、胸腺切除和甲状腺次全切除同时胸腺切除 ,并对这些病例进行术后随访。结果 :本组 7例 b 型病人中 2例由于气管切开所致颈部切口感染 ,经外科治疗后痊愈。3例 ( a 型 1例 , b 型 2例 )在单纯甲状腺次全切除术后 3～ 6个月 MG复发。2例 ( a型和 b 型各 1例 )在单纯胸腺切除术后 8个月和 1 2个月 MG复发。6例 ( 型 1例、 a 型 1例、 b 型 4例 )同时实施了甲状腺次全切除和胸腺切除术 ,术后 3个月 1例MG复发 ;3例 ( a 型 1例和 b 型 2例 )的 MG缓解 ,2例 ( b 型 )的 MG改善。结论 :MG并发甲亢病例同时实施胸腺切除和甲状腺次全切除疗效好 ,但由于气管切开增加了颈部切口感染的机会。MG并发甲亢时甲状腺次全切除或胸腺切除远期效果不理想。

? Objective:To study the clinical therapeutic characteristics of myasthenia gravis (MG) with hyperthyroidism and the effects of surgical procedures for the patients.Methods:Subtotal thyroidectomy,thymectomy,and simultaneous subtotal thyroidectomy and thymectomy were performed on eleven patients with MG and hyperthyroidism.These patients were followed up after the operation.Results:The neck incisions were infected in two of seven type Ⅱ b patients due to trachestomy and the infected incisions were surgically healed.The MG symptoms of three cases (1 cases in type Ⅱ a and 2 cases in type Ⅱ b) relapsed in 3 to 6 months after subtotal thyroidectomy.The MG symptoms of 2 cases (1 case in type Ⅱ a and 1 case in type Ⅱ b) relapsed in 8 to 12 months after thymectomy.Among six patients treated by simultaneous subtotal thyroidectomy and thymectomy,the MG symptoms relapsed in a type Ⅰ case 3 months after the operation,remitted in three case (1 case in type Ⅱ a and 2 cases in type Ⅱ b) and improved in two type Ⅱ b cases since the operations. Conclusion:The simultaneous subtotal thymectomy and thyroidectomy for patients with MG and hyperthyroidism might have better effects,although infective opportunity of the neck incisions increased owing to trachestomy.However,the prognostic effects were not very satisfactory whether simple subtotal thyroidectomy or thymectomy for the patients with MG and hyperthyroidism was performed.