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目的进行胸腺瘤分类标准的临床研究,以探讨胸腺瘤最新WHO病理分型与重症肌无力(MG)发生率、Osserman分型及手术预后的关系。方法回顾分析1974/2000105例因胸腺瘤行胸腺切除的患者,分别应用胸腺瘤的传统病理分类法、Levine-Rosai分类法及最新WHO分型标准对胸腺瘤分类,并在MG发生率、Osserman分型及手术预后等方面统计比较。结果(1)A型+AB型良性例数较多,B型恶性例数较多,体现出A型及AB型胸腺瘤良性的特点。(2)B3型较A型及AB型易合并MG(χ2=3.2948,P=0.07),C型13例均未合并MG。B3型胸腺瘤合并MG的手术危象发生率比A型+AB型、B1+B2型高,但统计学上无显著差异。(3)手术危象与Masaoka分期的良、恶性程度明显相关(χ2=4.2188,P=0.04),主要集中在Osserman改良分型Ⅱb型及Ⅲ型(χ2=13.0994,P<0.001)。结论胸腺瘤最新WHO病理分型对于区别良恶性肿瘤有指导意义;不同类型的胸腺瘤MG易患性不同,并且结合Osserman临床分型、Masaoka病理分期对提示术后危象有一定的应用价值。
Objective To study the classification criteria of thymoma in order to investigate the relationship between the latest histopathological classification of thymoma and the incidence of myasthenia gravis (MG), Osserman classification and surgical prognosis. Methods Retrospective analysis of 1974/2000105 cases of thymus resection for thymectomy patients, respectively, the use of thymoma traditional pathological classification, Levine-Rosai classification and the latest WHO classification criteria for thymoma classification, and the MG incidence, Osserman points Type and prognosis of surgery and other aspects of statistical comparison. Results (1) There were more benign cases of type A + AB and more malignant cases of type B, which showed the benign characteristics of type A and type AB thymoma. (2) Compared with type A and type AB, type B3 and type A were easily associated with MG (χ2 = 3.2948, P = 0.07). None of type C and type C included MG. The incidence of surgical crisis of type B3 thymoma combined with MG was higher than that of type A + AB and type B1 + B2, but there was no statistically significant difference. (3) There was a significant correlation between the surgical crisis and the Masaoka grade (χ2 = 4.2188, P = 0.04), mainly in Osserman type Ⅱb and Ⅲ (χ2 = 13.0994, P <0.001). Conclusions The latest WHO histological classification of thymoma is helpful for the differentiation of benign and malignant tumors. Different types of thymoma have different susceptibility to MG. Combined with Osserman clinical classification and Masaoka pathological staging, it is of certain value in presenting the postoperative crisis.