Operative Treatment of Myasthenia Gravis

雖然胸腺及重症肌無力症之關係尚未完全瞭解，但自1912年Sauerbruch從一重症肌無力的病患切除一腫大胸腺，而使該病人症狀獲得改善之後，陸陸續續有許多報告都認為胸腺摘除術能有效控制，甚至使症狀緩和至不必服藥的程度，經歷這些年來，胸腺摘除術已成為重症肌無力之基本治療方法。在過去12年來，高雄醫學院胸腔外科搜集了40位重症肌無力症接受胸腺摘除，並獲得追蹤之病人，年齡從13歲至68歲，臨床嚴重度以Osserman’s classification來評估，其平均追蹤時間為4年，結果remission rate為32.5%，improvement為27.5%，從手術remission平均為12個月，手術死亡率為5%。從本篇看出（Ⅰ）40歲以下接受手術者、（Ⅱ）發病至手術期間極短者、（Ⅲ）術前Osserman’s classification較低者及（Ⅳ）非瘤腫性胸腺者，比較能有好的豫後，另外Group Ⅰ與幼年時期重症肌無力症之手術與否，摘除術各種方法之利弊及胸腺摘除在其他免疫性疾病中的地位亦一併討論之。

關鍵字

無資料

並列摘要

Although the relationship between the thymus gland and myasthenia gravis is still not clear, it has been recognized for many years that, however, early thymectomy can bring about remission or improvement of disease. In the past 12 years, 40 myasthenic patients have received total thymectomies in the Department of Surgery, Kaohsiung Medical College Hospital. Their ages ranged from 13 to 68 years. They were classified according to Osserman’s classification. After an average follow up period of 4 years, the total remission rate was 32.5%, and the improvement rate was 27.5%. The average interval between thymectomy and onset of remission was 12 months. The operative mortality was 5% and overall mortality 10%. Patents who received thymectomies under 40 years of age, short duration between disease onset and the thymectomy, mider preoperative symptoms and nontumourous thymuses, seemed to have better prognoses. Early thymectomy in childhood myasthenia gravis is still controversial. Although generally the ocular type was treated in a conservative manner, we had a 40% rate of surgical remission in this group. Total longitudinal median sternotomy is our choice of approach because the operative field is larger and the thymectomy is more complete. Thymectomy in immune diseases other than myasthenia gravis is one of our important points for future studies.

並列關鍵字

thymectomy ； myasthenia gravis

國際替代計量

Operative Treatment of Myasthenia Gravis

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