摘要
目的总结重症肌无力（MG）胸腺切除术后症状缓解后又复发进展的诊治经验。方法回顾性分析22例行胸腺切除术后MG症状缓解后再复发患者的临床特点，观察以糖皮质激素和胆碱酯酶抑制剂为主的综合治疗措施的临床效果。结果全组术前改良Osserman分型Ⅰ型1例，Ⅱ型17例，Ⅲ型4例；复发进展后改良Osserman分型Ⅱ型15例，Ⅲ型6例，Ⅳ型1例，肌无力危象6例。治疗后完全缓解9例，部分缓解12例，死亡1例。结论MG胸腺切除术后缓解患者仍会出现复发进展，复发后以吞咽困难为主要症状的延髓型MG最常见，对胆碱酯酶抑制剂治疗反应差，合理应用糖皮质激素可使大多数患者缓解，降低病死率。
Objective To summarize the experience of clinical diagnosis and treatment for recurrence and progress of relieved myasthenia gravis after thymectomy. Methods 22 recurrent and progressive after relieved patients with myasthenia gravis who underwent thymectomy were retrospectively analyzed. The remission therapy was conducted with combined glucocorticoid and anticholinesterase and its effectiveness was estimated. Results It was 1 ,17,4 as better Osserman scaleⅠ,Ⅱ,Ⅲ respectively before operation but 15,6,1 as better Osserman scale , Ⅲ,Ⅳrespectively in recurrence and progress of relieved myasthenia gravis after thymectomy besides 6 with myasthenic crisis. Complete remission and partial remission were gained in 9 patients and 12 patients respectively. There was 1 hospital-death. Conclusions Recurrence and progress can occur in any patient of relieved myasthenia gravis after thymectomy. Bulbar myasthenia gravis is usually presented as dysphagia. Reasonable administration of glucocorticoid could improve majority of recurrence and progress of relieved myasthenia gravis after thymectomy but responses poorly to the anticholinesterases.
出处
《中国综合临床》
2009年第10期1073-1075,共3页
Clinical Medicine of China
