胸腺切除治疗重症肌无力手术时机的选择

Choosing Appropriate Readjustment of Surgery for Myasthenia Gravis Patients Undergoing Thymectomy

为探讨胸腺切除治疗重症肌无力合适的手术时机 ,对同济医院胸心外科 1981年～ 1996年运用胸腺切除术治疗的 74例重症肌无力患者进行回顾性临床分析。对照组 5例 ,为 1983年以前在病情不稳定期和未经皮质激素治疗的情况下手术的患者 ;研究组 6 9例 ,为 1983年～ 1996年在病情稳定期和用皮质激素治疗 1个月以后进行手术的患者 ,其中肌无力危象 9例 ,均在血浆交换后 1周内手术。结果发现术后近期加重反应发生率 :研究组为 14.5 % ,对照组为80 .0 % (P<0 .0 1) ;术后总缓解率 :研究组为 82 .6 % ,对照组为 2 0 .0 % (P<0 .0 1) ;死亡率 :研究组为 10 .1% ,对照组为 80 .0 % (P<0 .0 1) ,1例失访。研究组手术后疗效明显优于对照组。结果显示 :重症肌无力患者选择在病情稳定期 ,皮质激素治疗 1个月后和肌无力危象血浆交换治疗后 6～ 10 d以内手术 ,能提高手术安全性及近。

In order to investigate the appropriate opportunity of surgery for myasthenia gravis patients undergoing thymectomy, a retrospective clinical analysis on 74 myasthenia gravis patients receiving thymectomy in our hospital from 1981 to 1996 was performed. The patients were divided into two groups according to different treatments. Operation for the 5 cases in the control group was performed before 1983 and in unstable conditions without taking corticosteroids preoperatively, while in the study group ( n =69) the patients were operated when their states of illness was steady and had taken orally corticosteroids for at least one month preoperatively. In the study group, 9 patients with myasthenic crisis underwentthymectomy within 7 days after plasmpheresis because of failing to control their symptoms by medicine. Results showed the disease condition of about 14 1 % patients in the study group and 80 % patients in the control group become worse shortly after operation ( P <0 01). The total remission rate in the study group and control group was 82 6 % and 20 % respectively ( P <0 01). The mortality in the study group and control group was 10 1 % and 80 % respectively ( P <0 01). The therapeutic effectiveness after operation in the study group was more satisfactory than in the control group. It was demonstrated that to improve the security and the effectiveness of thymectomy for myasthenia gravis patients, the operation was performed on the patients who was in stable conditions and had taken corticosteroids orally for at least one month preoperatively, or those who received plasmpheresis within 7 days due to myasthenic crisis.