Clinical study of surgery for patients with myasthenia gravis and hyperthyroidism

摘要

Objective: To study the clinical therapeutic characteristics of myasthenia gravis (MG) with hyperthyroidism and the effects of surgical procedures for the patients. Methods:Subtotal thyroidectomy,thymectomy,and simultaneous subtotal thyroidectomy and thymectomywere performed on eleven patients with MG and hyperthyroidism. These patients were followedup after the operation. Results :The neck incisions were infected in two of seven type Ⅱ b patientsdue to trachestomy and the infected incisions were surgically healed. The MG symptoms of threecases (1 cases in type Ⅱ. and 2 cases in type Ⅱ b) relapsed in 3 to 6 months after subtotal thy-roidectomy. The MG symptoms of 2 cases (1 case in type Ⅱa and 1 case in type Ⅱ b) relapsed in 8to 12 months after thymectomy. Among six patients treated by simultaneous subtotal thyroidecto-my and thymectomy,the MG symptoms relapsed in a type I case 3 months after the operation,remitted in three case (1 case in type Ⅱ, and 2 cases in type Ⅱb) and improved in two type Ⅱ bcases since the operations. Conclusion:The simultaneous subtotal thymectomy and thyroidectomyfor patients with MG and hyperthyroidism might have better effects,although infective opportuni-ty of the neck incisions increased owing to trachestomy. However,the prognostic effects were notvery satisfactory whether simple subtotal thyroidectomy or thymectomy for the patients with MGand hyperthyroidism was performed.%目的：探讨重症肌无力(MG)并发甲状腺机能亢进(甲亢)病人的临床治疗特点和外科治疗的效果。方法：对11例患MG并发甲亢病人分别行甲状腺次全切除、胸腺切除和甲状腺次全切除同时胸腺切除，并对这些病例进行术后随访。结果：本组7例Ⅱb型病人中2例由于气管切开所致颈部切口感染，经外科治疗后痊愈。3例(Ⅱa型1例，Ⅱb型2例)在单纯甲状腺次全切除术后3～6个月MG复发。2例(Ⅱa型和Ⅱb型各1例)在单纯胸腺切除术后8个月和12个月MG复发。6例(Ⅰ型1例、Ⅱa型1例、Ⅱb型4例)同时实施了甲状腺次全切除和胸腺切除术，术后3个月1例MG复发；3例(Ⅱa型1例和Ⅱb型2例)的MG缓解，2例(Ⅱb型)的MG改善。结论：MG并发甲亢病例同时实施胸腺切除和甲状腺次全切除疗效好，但由于气管切开增加了颈部切口感染的机会。MG并发甲亢时甲状腺次全切除或胸腺切除远期效果不理想。