Ohuchi M, Shoji Y, Nakame T, Itoh Y, Ohmi M
Division of Thoracic and Cardiovascular Surgery, Sendai National Hospital, Japan.
Kyobu Geka. 1993 Jan;46(1):48-53.
From June 1975 to June 1992, we experienced 203 patients with MG. Sixty patients had associated thymoma, registering stages I (n = 31), II (n = 18), III (n = 9), and IV a (n = 2), according to the classification of Masaoka and colleagues. Fifty patients had generalized MG and 10 had ocular MG. Histopathological findings indicated round-oval, polygonal cell type in 46 patients and mixture of round-oval and spindle cell type in 11 patients and invasive thymomas had a tendency to have a predominantly epithelial type with and increased epithelial element as compared with non-invasive thymomas. An extended thymectomy including thymoma was performed in all patients. Three patients in stage II, 7 patients in stage III, and 2 patients in IV a received postoperative radiation therapy. Twenty-one patients needed prolonged respiratory care for respiratory crisis. Fifty-three patients have been doing well with the alternate-day corticosteroid therapy, however, 4 patients had an excavation of myasthenic symptoms associated with recurrence of thymoma on the pleura. In conclusion, early extended thymectomy including thymoma is markedly effective therapy for MG with thymoma and a careful attention should be paid for recurrence in the patients with invasive thymoma.
1975年6月至1992年6月期间，我们共收治了203例重症肌无力（MG）患者。其中60例伴有胸腺瘤，根据Masaoka及其同事的分类标准，分别为Ⅰ期（n = 31）、Ⅱ期（n = 18）、Ⅲ期（n = 9）和Ⅳa期（n = 2）。50例为全身型MG，10例为眼肌型MG。组织病理学检查结果显示，46例为圆形 - 椭圆形、多边形细胞类型，11例为圆形 - 椭圆形与梭形细胞类型的混合，与非侵袭性胸腺瘤相比，侵袭性胸腺瘤往往以上皮型为主，且上皮成分增加。所有患者均接受了包括胸腺瘤在内的扩大胸腺切除术。Ⅱ期的3例、Ⅲ期的7例和Ⅳa期的2例患者术后接受了放射治疗。21例患者因呼吸危象需要延长呼吸支持治疗。53例患者采用隔日皮质类固醇治疗效果良好，然而，有4例患者出现肌无力症状加重，与胸膜上胸腺瘤复发有关。总之，早期进行包括胸腺瘤在内的扩大胸腺切除术对伴有胸腺瘤的MG患者疗效显著，对于侵袭性胸腺瘤患者应密切关注复发情况。
