Guth S, Nix H W, Mayer E, Schmiedt W, Kramm T, Moersig W, Oelert H
Klinik und Poliklinik für Herz-, Thorax- und Gefässchirurgie, Johannes-Gutenberg-Universität Mainz.
Zentralbl Chir. 1997;122(8):655-60.
Myasthenia gravis is a relatively uncommon autoimmune disorder of neuromuscular transmission. Surgical therapy plays an important role in addition to medical treatment. Follow-up results of 52 patients with thymectomy are presented. Between 1984-1996 thymectomy via median sternotomy was performed in 52 patients with myasthenia gravis (female = 28, male = 24). The score described by Ossermann and Genkins was used for classification. According to this classification, we found 12 patients in class II(I), 21 in class IIA, 17 in class IIB and 2 in class III, respectively. A thymoma was found in 19, follicular lymphoid hyperplasia in 24 and an atrophic thymus in 9 cases, respectively. There was no mortality. Severe postoperative complications consisted of bleeding and reoperation in one patient and another patient developed a sternal instability with consecutive operative refixation. Follow-up evaluation after a mean period of 36 months (min. 6 months, max. 130 months) revealed a relief of myasthenic symptoms in 37 patients. Thymectomy is effective in the treatment of myasthenia gravis with a low complication rate.
重症肌无力是一种相对罕见的神经肌肉传递自身免疫性疾病。除药物治疗外，手术治疗也发挥着重要作用。本文展示了52例行胸腺切除术患者的随访结果。1984年至1996年间，对52例重症肌无力患者（女性28例，男性24例）实施了经正中胸骨切开术的胸腺切除术。采用Ossermann和Genkins描述的评分系统进行分类。根据该分类，我们分别发现II（I）类患者12例、IIA类21例、IIB类17例和III类2例。分别有19例发现胸腺瘤，24例发现滤泡性淋巴样增生，9例发现胸腺萎缩。无手术死亡病例。严重的术后并发症包括1例患者出血并再次手术，另1例患者出现胸骨不稳定并连续进行手术固定。平均随访36个月（最短6个月，最长130个月）后评估发现，37例患者的重症肌无力症状得到缓解。胸腺切除术治疗重症肌无力有效，并发症发生率低。
