论文部分内容阅读
目的:评价CT引导下经皮穿刺胸腺乙醇消融疗法对重症肌无力（MG）的治疗价值。材料和方法:31例MG,男13 例,女18例,年龄10～54岁,平均34岁。均根据典型的病史、体征、新斯的明试验和肌电图表现等作出诊断。按Osserman分型:Ⅰ型19例,Ⅲ型7例,Ⅳ型5例。胸腺增生25例,小胸腺瘤5例,正常胸腺1例,均经穿刺活检证实。取胸骨旁为穿刺点,用22G穿刺针在CT引导下穿入胸腺,分次注射无水乙醇,直至胸腺瘤或整个增生、正常胸腺充满乙醇为止。结果:治疗后即刻CT扫描,示胸腺内充满高密度影（乙醇混含对比剂）,3～4周CT复查,25例胸腺增生和1例正常胸腺彻底坏死,5例小胸腺瘤坏死。31例MG胸腺乙醇消融治疗后3个月CT复查,胸腺上下径、左右径、前后径与治疗前比较分别缩小了59.2％,68.6％,73.2％。30例MG于治疗后2天内都见效,其中23例在治疗后眼睑即能明显睁开。治疗后随访4年,显著好转23例,好转7例,无效1例。结论:CT引导下经皮穿刺胸腺乙醇消融疗法对MG具有确切疗效,安全易行,并发症少,是可供选择的微创治疗方法。
Objective: To evaluate the therapeutic value of CT-guided thoracic alcohol ablation therapy on myasthenia gravis (MG). Materials and Methods: 31 cases of MG, 13 males and 18 females, aged 10 to 54 years, mean 34 years. According to the typical history, signs, neostigmine test and EMG diagnosis. According to Osserman classification: 19 cases of type Ⅰ, 7 cases of type Ⅲ, 5 cases of type Ⅳ. 25 cases of thymus hyperplasia, 5 cases of small thymoma, 1 case of normal thymus, confirmed by biopsy. Take the parasternal point of the puncture point, with 22G needle puncture under the guidance of CT into the thymus, sub-injection of absolute ethanol until the thymoma or the entire proliferation of normal thymus filled with ethanol so far. Results: The CT scan immediately after the procedure showed that the thymus was filled with high density contrast agent (ethanol mixed with contrast agent), 3 to 4 weeks CT review, 25 cases of thymus hyperplasia and 1 case of complete thymus necrosis and 5 cases of small thymoma necrosis. 31 cases of MG thymus ethanol ablation after 3 months of CT review, thymus diameter, left and right diameter, anteroposterior diameter compared with before treatment were reduced by 59.2%, 68.6%, 73.2%. 30 cases of MG are effective within 2 days after treatment, of which 23 cases of eyelids that can be clearly opened after treatment. After 4 years of follow-up, significant improvement in 23 cases, improved in 7 cases, 1 case of ineffective. Conclusion: CT guided percutaneous thymus ethanol ablation therapy has the exact effect on MG, safe and easy to operate, with fewer complications, is an alternative minimally invasive treatment.