重症肌无力胸腺瘤患者手术治疗体会

Experience of surgical treatment of myasthenia gravis accompanined with thymomas

目的 总结胸腺瘤合并重症肌无力 (MG)患者的围手术期处理方法及治疗效果。方法 回顾分析 1990年 1月～ 2 0 0 3年 1月接受外科手术治疗的 2 8例胸腺瘤合并MG患者的临床资料 ,其中恶性胸腺瘤 6例。行胸腺及周围浸润组织完全切除 2 2例 ,胸腺瘤部分切除 6例。结果 全组无手术死亡 ,术后早期发生MG危象 7例 ,经及时气管插管或气管切开行呼吸机辅助呼吸等治疗 ,均抢救成功。术后随访 1～ 10年 ,MG完全缓解 2 2例 ,部分缓解 4例。按Osserman临床标准分型 :Ⅰ型 13例 ,ⅡA 型 8例 ,ⅡB 型 6例 ,Ⅲ型 1例。结论 合并MG胸腺瘤患者手术治疗效果肯定 ,加强围手术期处理 ,减少MG危象的发生 。

Objective To summarize the e xperience of surgical treatment and progn osis of myasthenia gravis(MG) accompanined with thymomas.Metho ds Twenty-eight(46.2%) cases of MG with surgically pr oved thymoma treated in this hospit al between Feb,1990 to Feb,2003 were analysed retrospectively of these cases,6 were malignant thymoma,22 were treated by total thymectomy.Res ults There was n o operative mortality.Seven cases suffered from crisis of myasthenia gravis.The duration of follow-up was 1-10 years,complete remission was obtained in 22 cases;partial remission was seen in 4 cases.According to Osserman clinical typin g,13 cases were type Ⅰ;8 cases were Ⅱ A;6 cases were Ⅱ B and 1 case was Ⅲ .Conclusions Thymoma accompanied with myasth enia gravis should be treate d by total thymectomy and the operative result is good.The good perioperative ma nagement may enhance the long-term curative efficacy in patients with MG accomp anied with thymoma.