胸腺手术治疗重症肌无力疗效评析(附76例报告)

The Evaluation of Therapeutic Effects of the Treatment of Myasthenia Gravis with Thymectory

目的 探讨胸腺手术治疗重症肌无力的利弊关系。方法 对手术治疗的重症肌无力患者 76例 ,结合临床分型和病理资料 ,进行术后疗效的观察和长期随访 ,根据病情的预后 ,结合文献分析胸腺手术与重症肌无力治疗中的相关问题。结果 胸腺病理改变与重症肌无力的临床类型的关系并不一致 ;术后随访 6个月至 7年 ,治愈率为 2 4 .2 % ,好转率为 2 2 .7% ,未愈率为 4 0 .9% ,病死率为 12 .1%。结论 胸腺手术治疗重症肌无力的疗效并不理想 ,危象发生率和肌无力复发率都相当高。结合文献提出胸腺手术治疗重症肌无力的适应症 ,并认为术后本病复发有其免疫学基础。

Objective To approach the advantages and disadvantages of the treatment of myasthenia gravis with thymectomy.Methods 76 examples of myasthenia gravis with surgical treatment,combining the clinical types and pathological materials,to carry observation of surgical effect and long term follow up;on the basis of prognosis,combining the documents we analysis the relevant problems of thymectomy and the treatment of myasthenia gravis.Results The pathological change of thymus is not always in accordance with the clinical types of myasthenia gravis.A follow up of 6 months to 7 years showed that the cure rate is 24 2%,improved rate 22 7%,unrecovered rate 40 9%,mortality 12 1%.Conclusion The effecy of thymectomy is not very satisfactory.The incidence of crisis and the recurrence rate is fairly high.Combining documents we put forword the adaption of surgical treatment of myasthenia gravis and the immunological basis of recurrence.The adjustment of immunosuppressive agents and anti cholinesterase drugs is still of great importance.