Wang Peijun, Zuo Changjing, Tian Jianming, Qian Zhong, Ren Fangyuan, Shao Chengwei, Wang Mingjie, Lu Taozheng
Department of Radiology, Changhai Hospital, 174 Changhai Rd., Shanghai, China 200433, USA.
AJR Am J Roentgenol. 2003 Sep;181(3):721-4. doi: 10.2214/ajr.181.3.1810721.
This study was designed to validate the therapeutic effectiveness of CT-guided percutaneous ethanol injection of the thymus for the treatment of myasthenia gravis.
The subjects were 45 patients with myasthenia gravis. The diagnosis was determined by the patients' histories, physical findings, neostigmine tests, and morphologic changes. According to the Osserman classification, the 45 patients with myasthenia gravis were classified as stage I (n = 26), stage III (n = 13), and stage IV (n = 6). A 21- or 22-gauge needle was inserted into the thymus under CT guidance, and then ethanol was injected step by step until it was distributed throughout the whole thymoma, the hyperplasia of the thymus, or the normal thymus. The amount of ethanol injected ranged from 2 to 13 mL, with a mean of 7 mL.
CT follow-up at 3-4 weeks showed that the thymus or thymoma was completely or mostly necrotized. CT follow-up at 3 months showed that the vertical, transverse, and anteroposterior dimensions of the thymus in all 45 myasthenia gravis patients decreased by 59.2%, 68.6%, and 73.2%, respectively, compared with those before percutaneous ethanol injection treatment. The therapeutic effect was observable clinically 2 days after treatment in 44 patients, including 36 patients who were able to open their eyes after treatment. A 5-year follow-up study showed that the condition markedly improved in 35 patients, improved in nine patients, and failed to improve in one patient who did not respond to the treatment. After treatment, 37 patients presented with low-grade fever (range, 37.3-37.7 degrees C; mean, 37.5 degrees C), which resolved 3 days later without treatment; all 45 patients complained of mild retrosternal pain after ethanol injection.
The therapeutic effect of CT-guided percutaneous ethanol injection into the thymus of patients with myasthenia gravis is definite. This procedure is safe and has low morbidity. CT-guided percutaneous ethanol injection is a minimally invasive alternative treatment for myasthenia gravis.
本研究旨在验证CT引导下经皮乙醇注射胸腺治疗重症肌无力的疗效。
研究对象为45例重症肌无力患者。诊断依据患者病史、体格检查、新斯的明试验及形态学改变确定。根据Osserman分类，45例重症肌无力患者分为Ⅰ期（n = 26）、Ⅲ期（n = 13）和Ⅳ期（n = 6）。在CT引导下将21或22号针插入胸腺，然后逐步注入乙醇，直至其分布于整个胸腺瘤、胸腺增生或正常胸腺。注入乙醇量为2～13 mL，平均7 mL。
3～4周的CT随访显示胸腺或胸腺瘤完全或大部分坏死。3个月的CT随访显示，与经皮乙醇注射治疗前相比，45例重症肌无力患者胸腺的垂直径、横径和前后径分别缩小了59.2%、68.6%和73.2%。44例患者在治疗后2天临床疗效可观察到，其中36例患者治疗后能够睁眼。一项5年的随访研究显示，35例患者病情明显改善，9例患者病情改善，1例患者治疗无效。治疗后，37例患者出现低热（范围37.3～37.7℃；平均37.5℃），未治疗3天后自行缓解；45例患者均诉乙醇注射后有轻度胸骨后疼痛。
CT引导下经皮乙醇注射重症肌无力患者胸腺的治疗效果确切。该方法安全，发病率低。CT引导下经皮乙醇注射是重症肌无力的一种微创替代治疗方法。
