Multiple Thymoma with Myasthenia Gravis: Report of a Case

A resected case of multiple thymoma is reported. The patient was a 47-year-old man with myasthenia gravis of Ossermann IIB type. Multiple thymomas were detected on a chest computed tomography scan and an extended thymothymectomy was performed. There were two separate thymomas in the anterior mediastinum: one measuring 60 × 60 mm and another measuring 25 × 25 mm in diameter, and both tumors pathologically consisted of predominantly lymphocytic forms. Received: November 9, 2001 / Accepted: July 2, 2002 Reprint requests to: H. Ishibashi     

胸腺切除治疗重症肌无力31例报告

自１９８８年７月～１９９５年７月施行胸腺切除术治疗各型重症肌无力３１例。胸腺瘤２０例（恶性６例），胸腺增生１０例，胸腺正常１例。３例术后死亡，２１例随访３月～６年零７月，结果满意。症状完全缓解９例，改善１０例，无变化１例，死亡１例。对病情严重者于胸腺切除术后早期行气管切开术，是预防术后呼吸衰竭的重要方法。结论：无论患者年龄多大或胸腺瘤病理类型如何，胸腺切除治疗重症肌无力是有效的。     

重症肌无力合并胸腺瘤的外科治疗(附31例报告)

报告１９８０年至１９９６年１０月手术治疗３１例重症肌无力合并胸腺瘤的结果。３１例占同期手术治疗１２０例重症肌无力之２５．８％。按Ｍａｓａｏｋａ分期属Ｉ期７例，Ｉ期８例，ＩＩ期１５例，ＩＶ期１例，术后１５例发生危象，均采用气管切开及辅助呼吸，１例死于危象。随访半年至８年，平均３７个月，５年内死亡６例，其中ＩＩ期４例，Ｉ期２例。结论：重症肌无力合并胸腺瘤术后危象的发生率远较未合并胸腺瘤者高，及时气管切开行辅助呼吸是处理的关键；胸腺瘤的Ｍａｓａｏｋａ病理分期与预后明显相关，肌无力的严重程度对预后亦有重要影响     

胸腔镜胸腺扩大切除治疗重症肌无力(附27例报告)

目的探讨胸腔镜胸腺扩大切除术治疗重症肌无力的可行性和疗效。方法2005年8月~2007年6月,对27例重症肌无力行电视胸腔镜下经右胸前侧径路胸腺扩大切除(VATS组),切除范围包括全胸腺组织到前纵隔和上纵隔所有脂肪组织。并与2004年5月~2005年7月27例胸骨劈开胸腺切除(胸骨劈开组)相对比。结果VATS组26例顺利完成手术;1例因电凝钩伤及头臂静脉干中转开胸止血。与胸骨劈开组比较,VATS组术中出血少[(46.0±5.7)mlvs(120.0±18.8)ml,t=-19.231,P=0.000],术后需镇痛例数少(3vs12,χ2=7.068,P=0.008),术后住院时间短[(7.0±1.2)dvs(11.0±2.5)d,t=-7.379,P=0.000]。2组手术时间、重症肌无力危象、疗效均无显著差异(P>0.05)。结论经右胸前侧径路胸腔镜下行胸腺扩大切除治疗重症肌无力在技术上可行,具有创伤小、疼痛轻、并发症少、住院时间短、恢复快等优点,但对MG的远期疗效尚需进一步观察。     

小儿重症肌无力的外科治疗

目的 探讨小儿重着肌无力（ＭＧ）的手术适应证,围手术期处理及影响疗效的有关因素。方法 按Ｏｓｓｅｒｍａｎ临床分型分为１型（单纯眼肌型）１１例,ⅡＡ型（轻度全身型）６例,ⅡＢ型（中度全身型）２例,胸腺病理检查;增生１２例,正常组织学表现７例,无合并胸腺瘤者。１２例腺腺标本进行了免疫组织化学观察。结果 全组无手型与疗效无关,根据免疫组织化学观察,１例,总有效率８９．５％,全身型术后缓解率７５％,较单纯     

单纯眼肌型重症肌无力胸腺切除的适应证探讨

目的许多学者对单纯眼肌型重症肌无力（ＰＯＭＧ）不主张手术治疗，为此，探讨ＰＯＭＧ胸腺切除的适应证。方法回顾性分析了１９８０～１９９６年１０月期间所行胸腺切除治疗ＰＯＭＧ２３例。结果２３例ＰＯＭＧ占所有重症肌无力１１７例的１７．９％，术后１例病理证实为胸腺瘤；随访１年有效率为９５．７％，１～３年８８．２％，３～５年９０．９％，超过５年为８７．５％。单纯眼肌型重症肌无力多见于儿童，合并胸腺瘤甚为罕见。结论单纯眼肌型病例行胸腺切除应严格控制，特别是儿童，只有症状严重而长时间对抗胆碱酯酶药物反应不佳或疑有胸腺瘤时才施行手术。     

40例胸腺肿瘤合并重症肌无力的手术治疗

报告４０例胸腺肿瘤合并重症肌无力（ＭＧ）的手术治疗效果。本组包括完全切除肿瘤和胸腺２６例，次全切除肿瘤１０例，组织活检４例。结果手术死亡１例（２．５％），术后１年内死亡８例（２０．５％）。３１例术后随访３～１２年，５年生存率为６１．３％，１０年生存率２７．７％；其中非浸润型胸腺瘤分别为７６．９％和３０．０％，浸润型胸腺瘤则为５０．０％和２５．０％。ＭＧ术后缓解改善率为８０．６％，术后肌无力危象发生率为４０．０％，抢救成功率为９３．８％，结论显示手术治疗胸腺肿瘤合并ＭＧ，如严格掌握手术指征，可获得较好的疗效和预后。     

重症肌无力症行胸腺切除术后危象的防治（附23例临床资料分析）

本文报告了重症肌无力症行胸腺切除术后危象２３例，占我科手术治疗１０７例重症肌无力病例的２１．５％，因危象死亡１例（４．３％）。通过对临床资料进行分析，作者认为，重症肌无力症行胸腺切除术后危象多数可以预测，发生危象与病人重症肌无力临床类型，术前服用抗胆碱酯酶药物剂量，是否合并胸腺瘤，术前曾发生危象以及肺通气功能障碍等因素有关。对于术前预测术后可能发生危象者，可于术毕行预防性气管切开，合理调整抗胆碱酯酶药物用药剂量，加强控制肺部感染等综合性防治措施。     

重症肌无力术后远期疗效

从１９９０年４月至１９９４年８月手术治疗重症肌无力１２４例，其中１０４例获得远期随访，随访期平均为２３．６个月。病人平均年龄２９．２岁；术前病程平均３４．２个月；根据改良Ｏｓｅｒｍａｎ标准分为Ｉ型２９例、Ｉａ型２３例、Ｉｂ型４１例、ＩＩ型１１例。随访疗效评价分成优、良、无效和差４等。结果显示总有效率为８２．７％、无效１３．５％、差１．９％。出院后２例死亡。统计处理表明，手术疗效与具体分型、术前病程长短有关，而与性别、胸腺病理类型无关，对１０岁以下病儿是否用手术治疗应慎重考虑。     

胸腺瘤合并重症肌无力的外科治疗

目的报告1988年～2000年12月手术治疗36例胸腺瘤合并重症肌无力(MG)的结果.方法全部患者均行手术治疗,按Masaoka临床分期Ⅰ期6例,Ⅱ期15例,Ⅲ期12例,Ⅳ期3例.结果术后18例出现重症肌无力危象,均行气管切开及辅助呼吸,1例死于危象.术后随访半年～10年,3年内MG缓解率为72.2%,5年生存率为65.4%,10年生存率为24.8%.结论胸腺切除手术是治疗胸腺瘤合并重症肌无力的主要方法,术后肌无力危象发生率高,及时行气管切开及辅助呼吸是处理的关键.     

Thymectomy Cures Diabetes Mellitus and Ameliorates Myasthenia Gravis in a Patient with Thymus Hyperplasia and Hyperthyroidism: Report of a Case

Myasthenia gravis (MG) is a devastating autoimmune disease that involves the acetylcholine receptor (AchR) in the postsynaptic membrane of the neuromuscular junction. It is not uncommon for MG to accompany with other autoimmune diseases and complicate with multiple organ dysfunction. Here, we report on an 18-year-old female patient with a rare case of MG concomitant with thymus hyperplasia, diabetes mellitus, and hyperthyroidism. After full excision of the hyperplastic thymus gland, the patient’s muscle weakness was greatly improved and her blood glucose level was restored to normal at the 6-month follow-up.     

Results of Surgical Treatment for Nonthymomatous Myasthenia Gravis

Purpose. To clarify the factors that influence improvement and remission after thymectomy for patients with nonthymomatous myasthenia gravis (MG).Methods. We retrospectively reviewed 204 patients with nonthymomatous MG who underwent thymectomy and anterior mediastinal dissection through a partial median sternotomy, between 1980 and 2001, and examined whether age, sex, preoperative classification, and duration of symptoms influenced their prognosis.Results. There was no perioperative or hospital mortality. The mean follow-up period was 7.2 ± 1.2 years, with early and late postoperative remission rates of 44.6% and 73%, respectively. Seven patients died; two from pneumonia and five from causes unrelated to MG. Preoperative treatment and classification, duration of symptoms, age, and sex did not seem to have a significant influence on remission, but the response to thymectomy was greater in patients with thymic hyperplasia. Remission and improvement rates were significantly better at the end of the first year, with the same status found at the last follow-up.Conclusion. Thymectomy is an effective and highly curative method of treatment for patients. with MG. It provides excellent symptomatic improvement, which is enhanced over the long term.     

电视胸腔镜经右胸前侧径路胸腺切除治疗重症肌无力

目的　探讨电视胸腔镜手术 (VATS)胸腺切除治疗重症肌无力的效果。　方法　 10例重症肌无力患者采用 VATS经右胸前侧径路行胸腺切除及纵隔脂肪清扫 (VATS组 ) ,并与 2 0例胸骨劈开胸腺切除 (胸骨劈开组 )相对照。　结果　 VATS组中 9例顺利完成手术 ,1例因电凝钩伤及头臂静脉干而中转开胸止血 ;全组无术后死亡及危象发生 ;手术时间、术后住院时间均较胸骨劈开组明显缩短。　结论　 VATS经右胸前侧径路行完全胸腺切除是可行的 ,且具有创伤小、恢复快等优点 ,可在临床进一步应用。     

同期双侧单孔胸腔镜手术治疗胸腺瘤合并重症肌无力

目的探讨同期双侧单孔胸腔镜下胸腺扩大切除术的可行性及早期手术效果。方法2017年8月~2019年6月,对20例胸腺瘤合并重症肌无力行同期双侧单孔胸腔镜下胸腺扩大切除术。切口位于腋前线和腋中线之间第4肋间,长3 cm。结果手术均顺利完成,手术时间(183.2±27.8)min,术中失血量(36.0±27.2)ml,胸腔引流时间(3.9±1.1)d,术后住院时间(6.1±1.4)d,病理测量瘤体最大径(4.3±1.3)cm。无围手术期并发症。Masaoka分期Ⅰ期2例,Ⅱ期16例,Ⅲ期2例(B2型和B3型各1例)。20例随访2~24个月,中位数14个月,总体缓解率90%(18/20)。结论同期双侧单孔胸腔镜下胸腺扩大切除术治疗胸腺瘤合并重症肌无力,手术安全,近期效果满意。     

Autoantibody to Gravin is Expressed More Strongly in Younger and Nonthymomatous Patients with Myasthenia Gravis

Gravin is expressed in several cell and tissue types as either 300 kDa doublet or 250 kDa proteolytic products. It is a cytoplasmic antigen that reacts with the serum of patients with myasthenia gravis (MG). Autoantibodies to gravin residues 1477–1781 are highly specific for MG. In the present study, we examined residues 1477–1781 in detail and found that residues 1542–1547 of gravin protein, which had sequence homology with the binding sequences of two protein A-kinase anchoring proteins, were highly reactive to MG serum. Antigravin antibody activities were stronger in younger and nonthymomatous patients. These findings suggest that antigravin antibody activities could be a useful prognostic factor and that the gravin antibody of MG may have a function which prevents the protein A-kinase binding pathway. Received: October 27, 2000 / Accepted: May 15, 2001