胸腺瘤病理与重症肌无力关系的研究  

A study of the relation between thymoma pathology and myasthenia gravis

作　　者：高政[1,2] 张东明[1,2] 宋贵军 苏昌明[1,2] 郑悦 刘丽梅 聂志余[1,2] 包礼平 

机构地区：[1]大连医科大学附属第二医院神经科 [2]大连市中医院

出　　处：《中华神经科杂志》1999年第3期139-141,共3页Chinese Journal of Neurology

摘　　要：目的探讨胸腺瘤Ｍａｓａｏｋａ病理分期、胸腺瘤病理分型与重症肌无力（ＭＧ）发生率、Ｏｓｅｒｍａｎ分型及预后关系。方法分析１９８６～１９９６年８８例胸腺瘤手术治疗后病理所见与临床表现。结果８８例胸腺瘤伴有ＭＧ２８例（３１．８％）。其中上皮细胞胸腺瘤３５例，并发ＭＧ１４例（４０．０％）：ＭＧ的Ｏｓｅｒｍａｎ分型Ⅱａ型５例（３５．７％），Ⅱｂ型８例（５７．１％），Ⅲ型１例（７．１％）。术后出现肌无力危象３例（２１．４％），死亡２例（１４．３％）。上皮淋巴细胞胸腺瘤４１例，并发ＭＧ１３例（３１．７％）：ＭＧ的Ｏｓｅｒｍａｎ分型Ⅰ型５例（３８．５％），Ⅱａ型８例（６１．５％）。术后出现肌无力危象１例（７．７％），死亡１例（７．７％）。淋巴细胞胸腺瘤８例，并发ＭＧ１例（１２．５％）；ＭＧ的Ｏｓｅｒｍａｎ分型为Ⅰ型，术后良好。梭形细胞胸腺瘤４例，无一例并发ＭＧ。２８例中２４例术后ＭＧ得到明显改善（８５．７％）。２８例胸腺瘤伴有ＭＧ患者的Ｍａｓａｏｋａ病理分期：Ⅰ期８例，Ⅱ期１０例，Ⅲ期１０例；Ⅰ期以Ｏｓｅｒｍａｎ分型Ⅰ型为主，Ⅱ、Ⅲ期以Ⅱａ、Ⅱｂ型为主。结论胸腺瘤病理分型和Ｍａｓａｏｋａ病理分期常常决定ＭＧ发生率、Ｏｓｅｒ?Objective To investigate the Masaoka pathological stages and types of thymomas, the incidence rate, as well as the Osserman type and prognosis of myasthenia gravis (MG). Methods To analyse the pathological sections and clinical manifestations of 88 cases who had received thymectomy from 1986 to 1996. Results Among the 88 cases, 28 cases (31.8%) were in MG. Among those of 35 cases with epithelial cell type thymoma, 14 cases (40.0%) were in MG, and their Osserman type a was 5 cases (35.7%), b 8 (57.1%), 1 (7.1%). 3 cases had MG crisis (21.4%), 2 cases were dead (14.3%). Among those of the 41 cases with epitheliallymphocytic cell type thymoma, 13 cases were in MG (31.7%) and their Osserman type was 5 cases (38.5%), a 8 (61.5%). One case had MG crisis (7.7%), one case was dead (7.7%). Among those of the 8 cases with lymphocytic thymoma, one was in MG (12.5%), and its Osserman type was 1 case and it is favorable after operation. Among those of the 4 cases with spindle cell type thymoma, none was in MG. All 24 MG cases were improved obviously (85.7%). 28 cases of thymoma were accompanied with MG and their Masaoka pathological stages. The first , second and third stages were shown 8, 10, and 10 cases respectively; the lst stage was relied mainly on Osserman type , and the 2nd and 3rd stages were relied mainly on Osserman type a and b. Conclusions The Masaoka pathological stage and type of thymoma may often determine the incidence rate, the Osserman type and the prognosis of MG. The more malignant the thymoma is, the more severe the MG and worse the prognosis.

关 键 词：重症肌无力 胸腺瘤 病理学 预后 

分 类 号：R736.302[医药卫生—肿瘤] R746.1[医药卫生—临床医学]