胸腺瘤切除术后重症肌无力的临床分析  

Myasthenia gravis occurring after resection of thymoma

作　　者：李鉴[1] 张德超[1] 汪良骏[1] 张大为[1] 张汝刚[1] 

机构地区：[1]中国医学科学院中国协和医科大学肿瘤研究所肿瘤医院胸外科,北京100021

出　　处：《中华外科杂志》2004年第9期540-542,共3页Chinese Journal of Surgery

摘　　要：目的　探讨胸腺瘤切除术后出现重症肌无力 (MG)患者的临床病理特点。方法　回顾性分析 15例胸腺瘤切除术后出现MG患者的临床资料 ,并与同时期手术平均随诊 5 5年未发现MG的全部 112例单纯胸腺瘤患者的临床资料比较。 15例胸腺瘤切除术后出现MG患者中女性 9例、男性 6例 ;胸腺瘤Masaoka分期Ⅰ期 7例、Ⅱ期 4例、Ⅲ期 4例 ;上皮细胞型 3例、淋巴细胞型 4例、混合型 7例、不定 1例。平均随诊时间为 76 7个月 (8～ 178个月 )。结果　 (1)胸腺瘤切除术后出现MG的时间为术后麻醉苏醒时至术后 137个月 (平均 33 9个月 ) ,MG症状完全缓解时间平均为术后 30 9个月 (0 5～ 12 0个月 ) ;(2 )麻醉苏醒时即出现MG的 4例患者中 ,均使用了非去极化肌松剂 ;(3)术后放射治疗患者中 3例出现MG(3/6 7) ,出现时间平均为治疗第 2 4天 ,已照剂量平均为 36Gy ;(4)女性、病程较长 ,混合型 ,肿瘤较大 ,病期稍晚者 ,可能有发生术后MG的倾向。结论　手术、术后放射治疗及麻醉中肌松药选择和剂量控制 ,均可影响术后MG的发生。ObjectiveThe aim of this study was to analyses the clinicopathologic features of the patient with myasthenia gravis (MG)occurring after resection of thymoma. MethodsData of 15 patients were collected. The follow-up range from 8 to 178 (average 76.7)months. A retrospective analysis was performed through comparison with data of all 112 cases without MG,which hadn′t occurred MG during our average 5.5 years follow-up,operated for thymoma in same period. The statistics analysis adopted χ 2 and t test. Results(1)Accoding to Masaoka′s classification of thymoma,stage Ⅰ in 7 cases,stage Ⅱ in 4,stage Ⅲ in 4. Histologic Bernatz′s classification: lymphocyte predominant type in 4,epithelial type in 3,mixed type in 7, unknow in 1. According to Osserman′s classification of MG,grade Ⅰ in 7,Ⅱa in 4,Ⅱb in 3,Ⅲ in 1. The MG onseting times was the postoperative narcotic waking duration-137(average 33.9)months,and the average remission time was 30.9(0.5～120) months.(2)4 cases who occur MG as soon as pull up narcotic tube,all adopted nondepolarizing muscular relaxants. (3)MG was discovered in 3 cases(3/67) during postoperative radiotherapy untill a average dosage of 36 Gy was received in average 24 days. (4)The tendency of occurring MG following resection was found in female patients with longer duration of disease,mixed type,larger and later stage thymoma as compared with the thymoma group. Conclusions The factors including the operation,relatively using overdose relaxometric control,choosing unfavorable muscle relaxant and postoperative radiotherapy could induce postoperative MG. An intensive care should be put on the cases with the tendency of occurring postoperative MG.

关 键 词：胸腺瘤 切除术 重症肌无力 临床分析 

分 类 号：R736.3[医药卫生—肿瘤] R746.1[医药卫生—临床医学]