| Objective:To investigate the clinical features of patients with myasthenia gravis combined with thymoma,and the efficacy of drug treatment and clinical outcome after myasthenia gravis combined with thymoma,and analyze the influencing factors.Methods:A total of 89 patients with myasthenia gravis combined with thymomas who had been treated at the Department of Neurology,cardiothoracic surgery,and inpatient departments of the First Affiliated Hospital of Nanchang University from January2007 to December 2017 were followed up for 12 months to collect clinical data of all patients.,Including the patient's gender,age,duration of disease,other diseases,type and duration of medication,age of thymus surgery,surgical methods,pathological types.1.89 cases of myasthenia gravis combined with thymoma were collected and analyzed according to gender,age,duration of disease,first symptom,MG classification,pathological type of thymoma,treatment plan and prognosis,and their clinical characteristics were summarized.2.The collected 54 patients with myasthenia gravis combined with thymus disease were divided into two groups: adherence to regular medications,and not following regular medications after surgery.According to MG's efficacy criteria,it was divided into remission group and invalid group.Through statistical analysis,the significance of postoperative drug treatment of MG with thymus disease was explored.3.Take 40 patients who adhere to regular postoperative drug treatment and retrospectively analyze the patient's medical records,including gender,age,disease duration,clinical classification of myasthenia gravis,type and duration of drug administration,thymus surgery,and thymus disease.Staging,thymus pathologicaltypes,etc.Explore the impact of its development and outcome predictions in MG.Results:1.In 89 patients with myasthenia gravis combined with thymoma,there were 50 male patients and 39 female patients;the patient's age ranged from 16 to 80(42.8±12.2)years old,of which the age of onset was 18 years or less and 2 cases,19 to 29 There were 8 cases of old age,23 cases of 30 to 39 years old,29 cases of 40 to 49 years old,18 cases of 50 to 59 years old,7 cases of 60 to 69 years old,and 2 cases of? 70 years old.The duration of the disease is 12 d to 15 years.According to the first symptom analysis: the first symptoms of extraocular muscle weakness as 70 cases,skeletal muscle weakness of the extremities as the first symptom in 13 cases,bulbar muscle weakness as the first symptom in 5 cases,respiratory muscle weakness as the first symptom in 1 case.Modified Osserman classification: 10 cases of type I(eye muscle type),21 cases of type IIA(mild systemic type),33 cases of type IIB(moderate systemic type),and 14 cases of type III(acute severe type),IV Type(delayed severe type)in 11 cases.According to the thymic tumor pathological WHO classification: 10 cases of thymic hyperplasia;7 cases of type A(medullary type),15 cases of type AB(mixed type),21 cases of type B1(organ type),and 17 cases of type B2(cortical type),B3 type(squamous epithelioid thymoma)in 9 cases.The thoracoscopic mediastinal tumor resection was performed in 61 cases.18 cases of median sternotomy were performed and 10 cases were refused surgical treatment.Fourteen patients were not treated with drugs.There were 40 cases of glucocorticoid+ bromopyrmine,7 cases of cyclophosphamide,10 cases of azathioprine,21 cases of high dose gamma globulin,and plasma exchange.One case and the other four cases.There were 29 cases of myasthenia crisis and 5 of them occurred after thymoma surgery.The duration of the crisis can reach 4 to 120 days,and the median time is17.0 days.There were 9 cases of thymoma B2 with muscle weakness crisis,7 cases of thymoma B3 type myasthenia crisis.2.In 54 patients with myasthenia gravis combined with thymoma surgery,there were 25 men(46.3%)and 29 women(53.7%);the oldest was 70 years old,and the youngest was 20 years old,with an average age of 46.5 years.The averagepreoperative course was(12.11±9.57)months,the shortest duration was 7 days,and the longest was 16 months.The experimental group was MG patients with thymus disease after regular drug use,a total of 40 cases,of which 33 cases were improved,7cases were ineffective;the control group was 14 cases of patients after regular drug use,including 8 cases of improvement,The invalid was 6 cases.Chi-square test and t-test showed that regular drug treatment was statistically significant in patients with myasthenia gravis combined with thymus disease(P<0.05).3.Of the 40 patients with myasthenia gravis who had regular medications after thymoma surgery,there were 33 patients in the improvement group,including 17males(51.5%)and 16 females(48.5%);7 patients in the ineffective group,including male 3 Cases(42.8%)and 4 women(57.2%).No significant statistical significance of gender on the sample was found.In patients with myasthenia gravis who used thymomas after regular drug administration,the age of the improved group was43.4±14.3 years;the age of the ineffective group was 54.1±15.2 years.The t-test showed that there was a statistically significant difference in age between the improved group and the ineffective group.significance.The average preoperative course of patients was(12.11±9.57)months,of which >12 months were 14 cases(35.0%),9 cases were better for rent,5 cases were ineffective;26 cases(65.0%)were?12 months,among them good There were 24 cases of subletting and 2 cases of invalid groups.The test shows that the length of the preoperative course has statistical significance for the improved group and the ineffective group.In the clinical Osserman classification,there were 19 cases(47.5%)of type I and IIA cases,13 cases improved,and 6 cases were ineffective;21 cases(52.5%)of type IIB and type III had a total of 20 cases,and 1 case was ineffective;There were 0 cases with V type,and there was statistical significance through data analysis.The stage I patients of Masaoka stage were 26 cases(65.0%),24 cases were improved,2 cases were ineffective;14 cases(35.0%)were stage II patients,9 cases were improved,5 cases were ineffective;stage III and IV patients were In 0 cases,the chi-square test had statistical significance.The pathological results of postoperative patients were collected,including 9 cases(22.5%)of thymic hyperplasia,31 cases of thymoma,4cases(10.0%)of type A thymoma in pathological WHO classification,3 cases ofimprovement,1 case ineffective;Nine cases(22.5%)of AB thymoma,8 cases improved,1 case ineffective;9 cases(22.5%)of B1 thymoma,7 cases improved,2cases ineffective;7 cases(17.5%)of B2 thymoma,improved 5 cases were ineffective in 2 cases;B3 thymoma in 2 cases(5.0%),improved in 1 case,invalid in 1 case;C-type thymoma in thymus cancer,0 cases.Data analysis of the sample did not find statistical significance.Conclusion:1,compared with non-thymic MG,MG patients with thymoma more common in men,and the peak incidence of 40 to 49 years old,clinical mostly systemic type,its B1,B2,AB type of pathological type is more common,its The incidence of myasthenia crisis,the difficulty of treatment is higher,and the prognosis is relatively poor.For such patients,active surgical treatment should be performed early,and postoperative immunosuppressive therapy should be standardized to prevent the occurrence of crises.2.A retrospective analysis of the clinical data of MG patients with combined thymic disease was performed.Patients were treated with cholinesterase inhibitor +hormone therapy following the doctor's advice.The patient's symptomatic remission rate was better than those who did not use regular drugs after surgery.3.A retrospective analysis of clinical data of patients with MG who combined thymic disease after regular drug use,chi-square test,t-test analysis showed: age,length of preoperative course,clinical Osserman classification,thymus masaoka stage is MG thymus Postoperative drug efficacy factors are important factors.However,gender and thymic pathological WHO classification has not yet been found to have an effect on postoperative drug treatment. |
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