32例重症肌无力伴胸腺瘤患者手术治疗疗效评价  

Evaluation of surgical treatment of 32 myasthenia gravis patients with thymoma

作　　者：杨倍[1] 陈晓峰[1] 王律[1] 姜格宁[1] 

机构地区：[1]同济大学附属上海市肺科医院胸外科,上海200433

出　　处：《中国癌症杂志》2009年第3期221-223,共3页China Oncology

摘　　要：背景与目的:重症肌无力是一种自身免疫性疾病,主要累及神经肌肉接头,约1/4的患者同时伴有胸腺瘤的发生,手术治疗无论对于重症肌无力或胸腺瘤这两种独立疾病都是十分有效的手段。为研究同时伴胸腺瘤的重症肌无力患者在手术治疗后的转归,我们回顾性分析我院手术治疗的伴胸腺瘤重症肌无力患者的临床资料和随访结果。方法:收集2001年1月至2006年12月手术治疗的32例胸腺瘤合并重症肌无力患者的临床资料并进行随访,观察胸腺瘤复发情况和重症肌无力术后转归,并对患者年龄、性别、病理类型和重症肌无力严重程度等因素进行分析。结果:围术期死亡1例,随访期内胸腺瘤复发1例,30例患者在随访期内(14～61个月)没有出现肿瘤复发;术后7例患者重症肌无力达到完全缓解,13例达到部分缓解,9例维持稳定,2例病情加重,总有效率为64.5%。具有不同年龄、性别、病理类型和重症肌无力严重程度等因素的患者之间,有效率的差异均无显著性(P<0.05)。结论:胸腺瘤合并重症肌无力患者手术治疗应当尽可能完整切除肿瘤、胸腺组织及周围脂肪组织,术后对侵袭性肿瘤患者进行放疗,对肿瘤复发患者可以实行再次手术切除,术后重症肌无力可以得到不同程度的缓解。Background and purpose： Myasthenia gravis（MG） is an auto-immune disease affecting neuromuscular joints. 1/4 of these patients may have thymoma. Surgical treatment remains the most important method for either MG or thymoma. In this retrospective analysis, we evaluated the clinical effects of surgical treatment for myasthenia gravis patients with thymoma. Methods： 32 myasthenia gravis patients with thymoma underwent surgical treatment between Jan 2001 and Dec 2006 in our hospital. The data including age, gender, pathological founding, duration and gravity of myasthenia gravis were analyzed. Tumor recurrence and outcome of myasthenia gravis were documented during follow-up for all patients. Results： All patients received median sternotomy for thymectomy. Resection of pericardium, pleural or part of lungs was taken as needed for complete removal of tumor tissue. One patient died during peri-operative time. The median follow-up period for the the rest of the 31 patients was 37（14-61） months. 8 patients received post-operative radiotherapy. Only one patient had recurrent thymoma and was re-operated, achieving tumor-free status. Complete remission of myasthenia was achieved in 7 patients with 13 partial remission, 9 stable and 2 progressed. The overall effective rate for myasthenia gravis was 64.5%, and patients with different data has no significance（P〈0.05）. Conclusion： Surgical treatment is effective for myasthenia gravis patients with thymoma. Aggressive resection and radiotherapy if necessary provide excellent local control of tumor. Most patients with myasthenia gravis could be relieved after surgery.

关 键 词：胸腺瘤 重症肌无力 外科治疗 

分 类 号：R730.56[医药卫生—肿瘤]