CAJ | 학술논문

目的总结重症肌无力(MG)胸腺切除术后症状缓解后又复发进展的诊治经验.方法回顾性分析22例行胸腺切除术后MG症状缓解后再复发患者的临床特点,观察以糖皮质激素和胆碱酯酶抑制剂为主的综合治疗措施的临床效果.结果全组术前改良Osserman分型Ⅰ型1例,Ⅱ型17例,Ⅲ型4例;复发进展后改良Osserman分型Ⅱ型15例,Ⅲ型6例,Ⅳ型1例,肌无力危象6例.治疗后完全缓解9例,部分缓解12例,死亡1例.结论 MG胸腺切除术后缓解患者仍会出现复发进展,复发后以吞咽困难为主要症状的延髓型MG最常见,对胆碱酯酶抑制剂治疗反应差,合理应用糖皮质激素可使大多数患者缓解,降低病死率.
목적 총결중증기무력(MG)흉선절제술후증상완해후우복발진전적진치경험.방법 회고성분석22례행흉선절제술후MG증상완해후재복발환자적림상특점,관찰이당피질격소화담감지매억제제위주적종합치료조시적림상효과.결과 전조술전개량Osserman분형Ⅰ형1례,Ⅱ형17례,Ⅲ형4례;복발진전후개량Osserman분형Ⅱ형15례,Ⅲ형6례,Ⅳ형1례,기무력위상6례.치료후완전완해9례,부분완해12례,사망1례.결론 MG흉선절제술후완해환자잉회출현복발진전,복발후이탄인곤난위주요증상적연수형MG최상견,대담감지매억제제치료반응차,합리응용당피질격소가사대다수환자완해,강저병사솔.
Objective To summarize the experience of clinical diagnosis and treatment for recurrence and progress of relieved myastbenia gravis after thymectomy. Methods 22 recurrent and progressive after relieved pa-tients with myasthenia gravis who underwent thymectomy were retrospectively analyzed. The remission therapy was conducted with combined glucocorticoid and anticholinesterase and its effectiveness was estimated. Results It was 1,17,4 as better Osserman scale Ⅰ , Ⅱ , Ⅲ respectively before operation but 15,6,1 as better Osserman scale Ⅱ , Ⅲ, Ⅳ respectively in recurrence and progress of relieved myasthenia gravis after thymectomy besides 6 with myas-thenic crisis. Complete remission and partial remission were gained in 9 patients and 12 patients respectively. There was 1 hospital-death. Conclusions Recurrence and progress can occur in any patient of relieved myasthenia gravis after thymectomy. Bulbar myasthenia gravis is usually presented as dysphagia. Reasonable administration of glucocor-tieoid could improve majority of recurrence and progress of relieved myasthenia gravis after thymectomy but responses poorly to the anticholinesterases.