摘要
目的探讨重症肌无力(myasthenia gravis,MG)合并胸腺瘤患者的临床病理特点及合理的外科治疗方案。方法回顾性分析47例MG合并胸腺瘤患者的临床资料。其胸腺瘤Masaoka病理分型Ⅰ期22例,Ⅱ期12例,Ⅲ期13例;MG改良Osserman法分型Ⅰ型20例,Ⅱa型14例,Ⅱb型7例,Ⅲ型6型。采用胸骨正中切口23例,前胸切口19例,后外侧切口5例。以累积生存率、MG转归为指标进行统计分析。结果本组平均随诊76.5(10～178)月。①11例(显性MG10例,隐性MG1例)术后围手术期出现肌无力危象(23.4%)。全组随诊共6例死于MG(12.8%),7例死于胸腺瘤(14.9%)。②显性MG32例,术后随诊5年总完全缓解率达34.4%,总改善率为62.5%。隐性MG15例,发作时间平均为术后37.7(0～137)d,出现MG后的5年自然缓解率为25.0%。③影响MG转归的因素为术后围手术期是否出现危象,出现者MG转归较差(P<0.05)。④经COX模型预后多因素分析,随诊中MG病情反复且有加重(优势比OR=2.16),胸腺瘤病理分期(OR=2.03)和手术方式(OR=1.63)为影响预后的主要因素。结论扩大胸腺切除术、术后肿瘤综合治疗、MG的围手术期综合处理及其长期治疗是提高疗效的有效手段。
Objective To investigate the clinicopathologic characteristics and surgical treatment of myasthenia gravis （MG） with thymoma. Methods 47 cases of MG with thymoma were retrospectively reviewed. All cases divided into stage Ⅰ in 22, stage Ⅱ, in 12, stage Ⅲ in 13 according to Masaokag classification of thymoma,and grade Ⅰ in 20, grade Ⅱ a in 14, grade Ⅱb in 7 ,grade Ⅲ in 6 according to modified Osserman＇s classification of MG. The operations performed via a median longitudinal sternotomy in 23 cases, anterior thoracic incision in 19 cases and posterolateral incision in 5 cases. Statistic analysis performed in terms of accumulated survival rate and MG turnover. Result All cases were followed up from 10 to 178 （average 76.5） months. ①Myasthenic crisis occurred in 11 cases including 10 cases of visible MG and 1 case of invisible MG. 6 cases （ 12.8% ） died of MG and 7 cases（14.9） dief of thymoma in follow-up duration. ②The complete remission rate and general remission rate were 34.4% and 62.5% in 32 cases of visible MG according to 5 years follow-up. The average onset time was postoperative 37.7 （0 ～ 137） days and the 5-year spontenous remission rate was 25% in 15 cases of invisible MG. ③The occurrence of myasthenic crisis was significantly correlated with a poor prognosis （P 〈0.05）. ④ Recurrence and deterioration of MG （OR =2.16）, pathological staging of thymoma （ OR =2.03） and type of resection （OR=1.63 ）were the independent prognostic variables according to COX multivariate regression model. Conclusion The extended thymectomy,comprehensive perioperative treatment, postoperative adjuvant therapy, and long-term follow up are the effective approaches to improve the prognosis.
出处
《中国现代手术学杂志》
2005年第4期251-254,共4页
Chinese Journal of Modern Operative Surgery
关键词
重症肌无力
胸腺肿瘤
预后
myasthenia gravis
thymus neoplasms
prognosis
