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目的观察重症肌无力合并胸腺瘤的手术治疗的近期疗效及危象发生的情况,分析疗效和危象的相关因素。方法 1994年1月至2005年1月手术治疗重症肌无力(MG)436例,其中58例合并胸腺瘤。肌无力按改良 Osserman 分型,Ⅰ型17例,Ⅱa型23例,Ⅱb型12例,Ⅲ型6例;胸腺瘤 Masaoka分期Ⅰ期30例,Ⅱ期18,Ⅲ期7例,Ⅳ期3例。对术后近期疗效和发生危象发生情况进行统计分析。结果手术后缓解16例(27.59%),无效18例(31.03%),恶化11例(18.97%),危象及死亡13例(22.41%)。logistic 回归分析发现,MG 合并胸腺瘤者发生危象的可能性是无胸腺瘤者的1.286倍,MG伴有胸腺瘤者、MGⅡ型及以上者是术后发生危象的高危人群。Ⅰ型与Ⅱ型及以上者术后近期的危象发生率差异有统计学意义(P<0.05)。Ⅰ期与Ⅱ期及以上胸腺瘤者术后近期的危象发生率差异无统计学意义(P>0.05)。结论 MG 合并胸腺瘤的病人术后危象的发生率明显增加,MGⅡ型及以上型术后更容易发生危象,危象的发生与胸腺瘤的病理分期无相关性。
Objective To observe the recent curative effect and the occurrence of crisis in surgical treatment of myasthenia gravis and thymoma and analyze the related factors of curative effect and crisis. Methods From January 1994 to January 2005, 436 cases of myasthenia gravis (MG) were treated surgically, of which 58 cases were complicated with thymoma. Myasthenia gravis according to modified Osserman classification, type I in 17 cases, type IIa in 23 cases, type IIb in 12 cases, type III in 6 cases; thymoma Masaoka stage I in 30 cases, stage II, stage 18, stage III in 3 cases . The postoperative short-term efficacy and the occurrence of crisis occurred statistical analysis. Results After operation, 16 cases (27.59%) were alleviated, 18 cases (31.03%) were ineffective, 11 cases (18.97%) were aggravated, and 13 cases (22.41%) were crisis and died. Logistic regression analysis showed that the risk of crisis in MG patients with thymoma was 1.286 times that of those without thymoma, MG patients with thymoma, and those with MGⅡ and above were the high risk group after operation. There was significant difference in the recent crisis rate between type Ⅰ and type Ⅱ and above (P <0.05). There was no significant difference in the recent crisis rate between stage Ⅰ and stage Ⅱ and above thymoma (P> 0.05). Conclusion The incidence of postoperative crisis in patients with MG thymoma is significantly increased. The crisis of MG Ⅱ type and above is more likely to occur after operation, and the occurrence of crisis has no correlation with the pathological stage of thymoma.