胸腺瘤与胸腺瘤合并重症肌无力患者的临床特点与围手术期临床处理  

Clinical features and experience of perioperative managements of thymomas with and without myasthenia gravis

作　　者：张华俊[1] 程远大[1] 高阳[1] 张位星[1] 常睿敏 张春芳[1] 

机构地区：[1]中南大学湘雅医院胸外科,长沙410008

出　　处：《中华胸心血管外科杂志》2017年第3期148-150,187,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 探讨胸腺瘤合并重症肌无力与单纯胸腺瘤或胸腺增生患者之间的临床病理差异,总结围手术期处理经验.方法 回顾性分析2010年6月至2016年6月收治的胸腺瘤患者的临床病理资料,对比分析单纯胸腺瘤或胸腺增生患者与胸腺瘤合并重症肌无力患者之间的异同.结果 273例胸腺占位患者,男150例,女123例,中位年龄48岁.合并副瘤综合征115例（42.1％）.无围手术期死亡,胸腔镜手术246例（90.1％）.与单纯胸腺瘤或胸腺增生组相比,合并重症肌无力的胸腺瘤组女性多（53.0％对39.5％,P=0.036）、年龄小[（46.6±12.9）岁对（50.6±14.32）岁,P=0.026]、住院时间长[（18.3±9.39）天对（14.6±5.69）天,P=0.000]、术后并发症发生比例高（22.0％对11.6％,P=0.027）、复发率低但差异无统计学意义（0对2％,P=0.274）.结论 胸腺瘤或胸腺增生患者无论是否合并副瘤综合征均推荐胸腺扩大切除.Objective To explore different clinical and pathological features of thymomas with and without myasthenia gravis（MG）,and accumulate the experience of perioperative managements.Methods Patients with thymoma admitted by our department between June 2010 and June 2016,were retrospectively reviewed.Results Of the 273 patieuts,150 were males and 143 were fenales（median age：48 years）.115 of all patients（42.1%） were combined with paraneoplastic diseases.There was no mortality during perioperative period.Video-assisted Thoracoscopic surgery was successfully performed for 246 cases（90.1%）.The female thymoma patients with with MG（TMG） were more than those without MG and thymic hyperplasia （53.0% VS 39.5%,P =0.036）.Compared to the thymoma patients without MG and thymic hyperplasia,the TMG was associated with younger age of onset [（46.6 ± 12.9） years VS.（50.6 ± 14.32） years,P =0.026],longer hospital stay [（18.3 ± 9.4）days VS.（14.6 ±5.7） days,P =0.000],higher postoperative complications morbidity（22.0% VS.11.6%,P =0.027）.Although the TMG has a lower recurrence rate,there was no significant difference between the two groups for recurrence rate（0 VS.2%,P =0.274）.Conclusion Extended thymectomy should be recommended for thymoma and thymic hyperplasia whether combined with or without paraneoplastic diseases.

关 键 词：胸腺瘤 重症肌无力 围手术期处理 

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]