摘要
目的 探讨胸腺瘤及胸腺瘤合并重症肌无力（MG）的临床特征.方法 回顾分析1979年10月～2004年7月外科治疗的185例胸腺瘤患者的临床资料,其中单纯胸腺瘤94例（胸腺瘤组）,胸腺瘤合并MG 91例（胸腺瘤合并MG组）;手术根治性切除155例（83.8%）,姑息性切除16例（8.6%）,探查术14例（7.6%）.分析两组患者的临床特点;按Masaoka病理分期法进行分期,运用寿命表法计算生存率,分析影响预后的因素.结果 术后死亡5例,其余均缓解或治愈.两组患者的Masaoka病理分期差异有统计学意义（χ2=53.14,P＜0.05）;胸腺瘤病理分型与MG临床分型、病理分期差异无统计学意义（χ2=8.21,P＞0.05）.胸腺瘤组随访57例,随访1～10年,平均随访40.7个月,1、3、5年生存率分别为 70.2%（40/57）、66.7%（22/33）、59.3%（16/27）;胸腺瘤合并MG组随访55例,1、3、5年生存率分别为98.2% （54/55）、86.4%（38/44）、81.6%（31/38）,比较两组1、3、5年生存率差异无统计学意义（χ2=0.83,P＞0.05）. 随访112例中,Masaoka病理分期5年生存率分别为Ⅰ期93.7%,Ⅱ期79.2%,Ⅲ期51.4%,Ⅳ期0%,各分期比较差异有统计学意义 （χ25年=51.62,P＜0.01）.结论 胸腺瘤的病理类型与MG的临床分型无关,胸腺瘤术后生存率与分期显著有关,与是否合并MG无关.胸腺瘤伴MG以全身型为主,病理类型以淋巴细胞型常见.胸部CT检查有助于早期发现胸腺瘤.治疗原则应尽可能广泛切除肿瘤,术后根据具体情况辅以放疗、化疗.手术方式、病理分期对预后影响较大.
Objective To investigate the clinical characteristics of thymoma and thymoma with myasthenia gravis（MG）. Methods From Oct. 1979 to July 2004,185 patients with thymoma were surgically treated. Among these patients, comparative analysis was made between 94 cases of thymoma （thymoma group） and 91 cases of thymus tumor with MG（thymoma with MG group）. 155 patients underwent radical operation （83.8%）, 16 patients underwent palliative operation （8.6%）, and 14 patients underwent exploratory operation （7.6%）. Clinical characteristics was analyzed in two groups. The factors affecting prognosis was analyzed by Masaoka＇s stage system, with the liftable method. Results Five patients died after operation, others had complete remission or symptomatic improvement. There was statistically difference of Masaoka＇s stage system in two groups （X^2= 53.14, P 〈 0. 05）. There were no statistically difference in pathological type of thymoma and clinical type of MG and pathologic period （X^2= 8.21, P〈0. 05）. 57 cases of thymoma group were followed up, the duration of follow-up was 1 to 10 years, average follow-up was 40. 7 months, and the patients with 1-, 3- and 5-year survival rates were 70. 2% （40/57）, 66.7% （22/33）, 59.3% （16/27） respectively. 55 cases of thymoma with MG group were followed up. The patients＇ survival rates were 98. 2% （54/55）, 86. 4% （38/44）, 81. 6% （31/38） at 1-, 3- and 5-year respectively. There was no statistically difference of survival rates in two groups （X^2= 0. 83, P〉0.05）. Totally, 112 patients were followed up in two groups, by Masaoka＇s stage system, the 5-year survival rates were 93.7 % for stage Ⅰ , 79.2% for stage Ⅱ , 51.4% for stage Ⅲ and 0% for stage Ⅳ respectively. Result of Masaoka＇s stage system evidence was statistically significant （X^2 5-year= 51. 62, P〈0. 01）. Conclusions Pathological type of thymoma isn＇t related to modified Osserman＇s classification, prognosis of thymoma is obviously related to Masao
出处
《中国胸心血管外科临床杂志》
CAS
2007年第2期108-111,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
胸腺瘤
重症肌无力
病理学
治疗
预后
Thymoma
Myasthenia gravis
Pathology
Therapy
Prognosis
