合并胸腺瘤对胸腺切除治疗重症肌无力效果的影响  

Influence of concomitant thymoma on effect of thymectomy for myasthenia gravis

作　　者：李剑锋[1] 崔健[2] 杨帆[1] 刘彦国[1] 卜梁[1] 隋锡朝[1] 王俊[1] 

机构地区：[1]北京大学人民医院胸外科,100044 [2]北京市海淀医院胸外科

出　　处：《中华胸心血管外科杂志》2012年第8期470-472,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结胸腔镜胸腺扩大切除治疗重症肌无力的远期疗效，并分析合并胸腺瘤对手术疗效的潜在影响。方法2001年4月至2009年10月47例重症肌无力接受胸腔镜手术的患者分为有胸腺瘤组和无胸腺瘤组两组，评价肿瘤因素对重症肌无力胸腔镜手术效果的影响。结果47例中男20例，女27例；平均年龄36．6岁。根据美国重症肌无力基金会（MGFA）分型：I型18例、Ⅱa型14例、Ⅱb型14例、Ⅲa型1例。胸腺瘤组22例，无瘤组25例。随访至2011年6月，无瘤组随访20～122个月，平均57个月；失访2例。无瘤组完全稳定缓解（CSR）78．3％，药物缓解（PR）13．0％，微小症状表现（MM）4．3％，无恶化（W）0，无复发（E）0，死亡（D）（4．3％）。胸腺瘤组分别为：50．0％、22．7％、13．6％、4．5％、9．1％和0。结论胸腔镜胸腺扩大切除治疗重症肌无力远期疗效满意，无瘤组在完全缓解率上优于有瘤组，但在总有效率上两组差异无统计学意义。Objective To evaluate the long term effect of video-assisted thoraeoscopie thymectomy for myasth,enia gra- vis and the influence of concomitant thymnma. Methods 47 cases of myasthenia gravis were retrospectively reviewed who had received video-assisted thoracoseopic thymectomy from Apr. 2001 through Oct. 2009. The patients were separated to two groups with or without thymoma. Influence of oncologic factors was carefully studied. Results There were 20 males and 27 females with a mean age of 36.6 yrs. According to the typing system of the Myasthenia Gravis Foundation of America （MGFA） , the patients belonged to type I 18 cases, type n a 14 cases, type IIb 14 cases, and Ilia 1 case. 22 patients were in the group with thymoma, and the other 25 in the group without thymoma. Until the deadline of follow-up time of Jun. 2011, only two ca- ses in non-thymomatous group were lost. Follow-up time was 20 to 122 months, mean 57 months. The complete stable remis- sion rate （CSR） , pharmacologic remission （PR） , minimal manifestations （ MM ） , worse （W） , exacerbation （E） and died of my- asthenia gravis（D） in non-thymomatous group were 78.3 % , 13.0% , 4.3 % , 0, 0 and 4.3 %. In thymomatoas group the values were 50.0% , 22.7%, 13.6% , 4.5% , 9.1% and 0. Conclusion Video-assisted thoarcoscopic thymectomy has a satisfactory long term effect for myasthenia gravis. Thymomatous group has no different in overall effectiveness with that of non-thymomatous group although a probably lower complete stable remission rate is prompted.

关 键 词：胸腔镜检查 胸腺切除术 重症肌无力 胸腺瘤 

分 类 号：R746.1[医药卫生—神经病学与精神病学] R736.3[医药卫生—临床医学]