胸腺瘤病理分型与重症肌无力关系的研究

Study on the relationship between the pathology of thymoma and myasthenia gravis

目的 探讨胸腺瘤最新WHO病理分型与重症肌无力 (MG)发生率、其他病理分型及手术预后的关系。方法 回顾分析 1974～ 2 0 0 0年 10 5例因胸腺瘤行胸腺切除的患者 ,分别应用胸腺瘤的传统病理分类法、Levine Rosai分类法及最新WHO分型标准对胸腺瘤进行分类 ,并在MG发生率及手术预后等方面分析比较。结果 (1)WHO病理分型A型 +AB型良性病例较多 ,B型恶性病例较多 ,体现出A型及AB型胸腺瘤良性的特点。 (2 )B3型较A型及AB型易合并MG(P <0 .0 5 ) ,C型 13例均未合并MG。B3型胸腺瘤合并MG的手术危象发生率比A型 +AB型组、B1+B2型组高 ,但统计学上无显著差异。 (3)Masaoka分期的良、恶性程度与手术危象明显相关 (P <0 .0 5 )。手术危象主要集中在Ⅱb型及Ⅲ型中 (P <0 .0 0 1)。结论 胸腺瘤最新WHO病理分型对于区别良、恶性肿瘤及预后有指导意义 。

Objective To investigate the relationship between the latest WHO criteria of thymic epithelial tumours(TET) and the incidence of MG,Osserman classfication and postoperative prognosis of myasthenia gravis(MG). Methods To analyse the pathological sections of 105 patients with thymoma from 1974 to 2000 with Levine-Rosai's clinicopathological classification,traditional histological classification and WHO classification respectively,and analyse and compare their relevance with the incidence,Osserman classification and postoperative prognosis of MG.Results (1)The cases with benign tumors of type A and type AB were more than those of type B.(2)Type B3 more likely accompanied MG than type A and type AB (P< 0.05),while none accompanied MG among 13 cases of type C.The incidence of postoperative crisis in type B3 with MG was higher than that of the other types,but no evidence was found in statistics.(3)Postoperative crisis closely correlated with Masaoka clinical stage and postoperative crisis(P< 0.05).(4)The postoperative crisis mainly occurred in Osserman type Ⅱb and type Ⅲ (P< 0.001).Conclusion The lastest WHO classification has a directive significant to distinguish benign thymoma from malignant thymoma, and it has certain applied value to postoperative crisis combining Osserman classification,Masaoka clinical stage.