胸腺切除术并类固醇疗法治疗伴胸腺瘤的重症肌无力的远期疗效观察

丛志强　万顺伦　王海萍　阮喜云 中国神经免疫学和神经病学杂志 1999年第2期第6卷

　　摘要　目的　评价胸腺切除术并皮质类固醇疗法对伴胸腺瘤的重症肌无力患者的远期疗效。方法　对采用胸腺切除术并类固醇疗法治疗的52例伴胸腺瘤的重症肌无力患者作回顾性研究，经术后1～20年，平均(4.5±3.6)年的长期随访，评价其远期有效率和存活率。结果　远期有效率为88.5%(46/52)，病死率11.5%(6/52)。在46例远期存活者中，8例获完全缓解(15.4%)，29例获药物缓解(55.8%)，9例明显改善(17.3%)。5年存活率86.4%，10年存活率33.3%。结论　本研究结果提示胸腺切除术并皮质类固醇疗法治疗伴胸腺瘤的重症肌无力患者的远期疗效良好，该疗法对降低术后病死率和提高缓解率有重要作用。

　　中图号　R746.1

The Long-term Outcome of Thymectomy Combined with Steroid Therapy for 52

　　Myasthenia Gravis Patients Associated with Thymoma

Cong Zhiqiang　　Wan Shunlun　　Wang Haiping　　Yuan Xiyun

　　(Department of Neurology,the Affiliated Hospital of Qingdao Medical College,Qingdao 266003)

　　Objective　To evaluate the long-term outcome of thymectomy combined with corticosteroid therapy for myasthenia gravis (MG) with thymoma. Methods　Fifty-two MG Patients with thymoma treated with thymectomy combined with corticosteroid therapy underwent a retrospective study during a follow-up period of 1 to 20 years (mean4.5±3.6years) after thymectomy in order to evalute the long-term effective rate and survival rate. Results　The long-term effective rate was 88.5% (46/52),mortality was 11.5%(6/52).In 46 survivors,8 of them obtained complete remission (15.4%)，29 of them pharmacological remission (55.8%)，9 of them marked improvement (17.3%).The overall 5-year survival rate was 86.4%，the overall 10-year survival rate was 33.3%. Conclusions　The long-term therapeutic results of thymectomy combined corticosteroid therapy were good for MG patients with thymoma.This therapeutic measure played an important role in decreasing mortality and increasing remission rate.

　　Key words　　myasthenia gravis;thymoma;thymectomy;corticosteroid therapy;long-term outcome

　　有数份报告指出胸腺切除术对伴胸腺瘤的重症肌无力(myasthenia gravis,MG)的疗效不佳，而且有增加术后病死率的危险［1，2］。本文报告胸腺切除术并类固醇疗法治疗52例伴胸腺瘤MG的远期预后的回顾性研究结果。

　　1　对象和方法

　　1.1　患者　本组52例MG患者均经新斯的明或滕喜龙试验阳性确诊。其伴有的胸腺瘤均经胸片、纵隔CT或纵隔MRI检查后作出诊断并经手术证实。其中男35例和女17例，MG的发病年龄8～61岁，平均(38

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