带血管胎胸腺移植治疗重症肌无力的研究  

Study on the treatment of myasthenia gravis with transplantation of blood pedicle fetus thymus

作　　者：王胜发[1] 王凯[1] 杨成[1] 王巨[1] 王柏春[1] 张铁娃[1] 

机构地区：[1]哈尔滨医科大学第一临床医学院胸外科,150001

出　　处：《中华器官移植杂志》2001年第5期296-297,共2页Chinese Journal of Organ Transplantation

基　　金：黑龙江省科委重点攻关课题资助 (G97C180 4 0 2 )

摘　　要：目的　探讨胎胸腺移植治疗重症肌无力的效果。方法　对 5例胸腺切除后重症肌无力症状无改善的重症肌无力患者施行胚胎胸腺移植 ,供者为胎龄小于 6个月的水囊引产死胎 ,将带血管的胎胸腺移植于受者的腹股沟区 ,胎胸腺的上腔静脉与受者的近端大隐静脉吻合 ,胎胸腺的升主动脉及降主动脉分别与受者的旋股外侧动脉近心端及离心端吻合。术后观察受者的外周血T淋巴细胞亚群的变化。结果　 5例移植的胎胸腺均存活 ,无排斥反应 ,移植后随访 2～ 19个月 ,肌无力症状明显缓解 ,不需口服胆碱酯酶抑制剂和激素类药物 ;术后外周血CD3 +、CD8+细胞水平升高 ,CD4 +/CD8+比值下降。结论　采用带血管的胎胸腺移植治疗重症肌无力 ,具有作用持久、不改变细胞生长的微环境等优点。Objective To review the treatment of myasthenia gravis (MG) with the transplantation of blood pedicle fetus thymus. Methods The dead fetus less than 6 months after induction of labor with water bag were transplanted to the patients who received thymectomy without good effects. The prepared thymus was anastomosized by using vein to vein and artery to artery method. The changes of sub group of T cell were observed after transplantation. Results All the transplanted thymus were survival without rejection and the patients were followed up for 2 to 19 months. The symptoms of myasthenia were relieved without oral intake of neostigmine and corticosteroids. The CD3 and CD8 levels were increased as compared with those before operation and the ratio of CD4/CD8 decreased. The normal immuno function of the patients was restored. Conclusions The treatment of MG with the transplantation of blood pedicle fetus thymus could obtain better blood supply with less injury and maintain the thymus action much longer due to unchanged micro-environment of cell. It can avoid the retrogeneration and apoptosis of the fetus thymus. The method might bring a bright future for the patients with MG.

关 键 词：重症肌无力 胸腺移植 胎儿 治疗 手术方法 

分 类 号：R655.7[医药卫生—外科学]