135例胸腺瘤的诊断和外科治疗.docVIP

135例胸腺瘤的诊断和外科治疗 　　作者：潘文标,曹子昂,顾旭东,钱晓哲,郑家豪 作者单位：(上海交通大学医学院附属仁济医院 胸心外科,上海 200001) 　　【摘要】 目的:总结胸腺瘤的诊断和外科治疗经验。方法：回顾性分析2001年1月至2008年12月在我科手术治疗的135例胸腺瘤患者的临床资料。结果：肿瘤完整切除123例,部分切除12例,肿瘤完整切除率91%(123/135)。住院死亡1例。5年内复发8例,复发率6%(8/134);11例失随访。重症肌无力(MG)发生率为40%(54/135),术后MG症状完全缓解21例(溴吡啶斯的明停药),改善30例(溴吡啶斯的明剂量显著减少),改善不明显或加重3例(溴吡啶斯的明需维持原剂量、增加剂量或加用皮质激素等)。结论：胸部增强CT等影像学检查是诊断胸腺瘤的主要手段。重症肌无力是常见伴随症状;胸腺瘤不宜单纯切除,无论病理分期如何均应行扩大切除,以降低复发率;Ⅱ期及以上病变进行综合治疗可提高疗效。 　　【关键词】 胸腺瘤; 重症肌无力; 诊断; 外科治疗 　　Diagnosis and surgical treatment of 135 cases of thymoma 　　PAN Wenbiao, CAO Ziang, GU Xudong, QIAN Xiaozhe, ZHENG Jiahao(Department of Thoracic and Cardiovascular Surgery, Renji Hospital, Medical College of Shanghai Jiaotong University, 　　Shanghai 200001, China) 　　[Abstract] Objective: To summarize the experience in the diagnosis and surgical treatment of thymoma. Methods: 135 patients with thymoma, surgically intervened and pathologically confirmed in Renji Hospital from Jan 2001 to Dec 2008, were retrospectively analyzed. Complete resection of the tumor was performed in 123 patients (91%), partial or incomplete resection in 12(9%). Results: One patient died after operation, 123 cases were followed up, and 8 cases recurred. The 3and 5year survival rates were 89% and 75% respectively. By Masaokas stage system, the 3 and 5year survival rates were 70% and 46% respectively for stage Ⅲ and stage Ⅳ. Conclusion: The imaging examination, such as chest CT, is the main diagnostic method for thymoma. Myasthenia gravis is a common concomitant disease in patients with thymoma. Regardless of clinical staging and histology, complete surgical resection is certainly the gold standard to achieve cure, which helps to reduce the recurrence. Combination with other methods (including chemotherapy and radiotherapy) after operation may improve symptoms and prolong life span in the patients with thymomas, including stages Ⅱ，Ⅲ and Ⅳ. 　　[Key words] thymoma; myasthenia gravis; diagnosis; surgical treatme