310例重症肌无力的外科治疗

310 cases of thymectomy for myasthenia gravis

目的 评价胸腺切除术治疗重症肌无力的围手术期临床特点及疗效。 方法 回顾性分析 310例经胸腺切除术治疗重症肌无力患者的临床特点、手术方式、围手术期处理及疗效。以临床绝对评分及相对评分为治疗前后疗效主要判断标准。 结果 全组无手术死亡 ,直接手术并发症8 7% (2 7/310 )。术后病理检查 ,异位胸腺发生率 38 7% (12 0 /310 ) ,胸腺增生达 92 9% (2 88/310 )。术后随访 3个月以上者 2 87例 (随访率为 92 6 % ) ,痊愈 7 1% (2 2 /310 )、基本痊愈 11 3% (35 /310 )、显效4 0 0 % (12 4 /310 )、好转 2 7 1% (84 /310 )、无效 7 1% (2 2 /310 ) ,总有效率 85 5 % (2 6 5 /310 )。其中随诊病例中Ⅰ型、Ⅱa型、Ⅱb型、Ⅲ型、Ⅳ型有效率分别为 90 9% (2 0 /2 2 )、97 6 % (40 /4 1)、95 3% (16 2 /170 )、80 6 % (2 9/36 )和 77 8% (14 /18)。 结论 全身型及部分眼肌型重症肌无力患者可首选扩大胸腺切除术治疗 。

Objective To evaluate the clinical characteristics and long term outcome of 310 cases of thymectomy for myasthenia Gravis. Methods The data of 310 patients with thymectomy were analyzed retrospectively to study the patient selection, operative techniques, perioperative management and results for myasthenia Gravis. Absolute and relative scores for clinical evaluation were used as the criteria to determine the therapeutic effects of thymectomy. Results There were no operative death and postoperative complication rates were 8 7%(27/310). The extra anatomic thymic tissue was found in up to 38 7%(120/310)patients and thymus hyperplasia occurred in 92 9%(288/310)cases. 92 6%(287/310) postoperative patients were followed up for 3 or more months; the percentage of patients being remitted, essentially remitted, significantly effective, effective and non effective were 7 1%(22/310), 11 3%(35/310) 40 0%(124/310), 27 1%(84/310), 7 1%(22/310) respectively. The total long term effective rate was 85 5%(265/310). The effective rate for type Ⅰ, Ⅱa,Ⅱb,Ⅲ, Ⅳ was 90 9%(20/22), 97 6%(40/41), 95 3%(162/170), 80 6%(29/36), 77 8%(14/18) respectively. Conclusions Generalized typed and properly selected recurrent ocular typed patients with Myasthenia Gravis undergoing extensive thymectomy would have good long term outcomes.