重症肌无力伴恶性胸腺瘤的联合化疗

目的：探讨重症肌无力伴恶性胸腺瘤难治病例联合化疗的可行性及疗效。方法：4例重症肌无力伴恶性胸腺瘤患者，按细胞增殖周期，采用经改进组成的CEVD联合化疗方案，即静脉滴注环磷酰胺(CTX)、表柔比星(EPB)、长春新碱(VCR)及口服地塞米松(DXM)，初每月1个疗程，重复3～6个疗程，后酌情延长疗程间歇，逐步减少剂量至停药。结果：随访1～3年，4例经联合化疗1～5个疗程，均有显著疗效，全身肌力好转，未再发生危象及肿瘤复发。其中2例患者胸腺瘤纵隔局部广泛浸润、术后复发转移、再次手术发生危象，经联合化疗后无力症状消失，其中1例已恢复工作；另1例生活正常(已退休)。4例患者均未发生严重不良反应。结论：联合化疗对难治的伴有恶性胸腺瘤的重症肌无力患者有较好疗效。

Combined chemotherapy for myasthenia gravis with malignant thymoma

Objective:To probe the feasibility and treatment efficiency of combined chemotherapy for 4 rnyasthenia gravis patients with malignant thymoma (MGMT). Methods: According to the cell cycle of malignant thymoma, the modified chemotherapy of CEVD scheme was cytoxan, epirubicin and vincristin intravenousely and dexamethasone orally once a month for 3-6 times. Then the treatment was ceased gradually; the side effect and efficiency were observed. Results :Followed-up for 1-3 years, 4 MGMT patients received combined chemotherapy (for 1-5 courses) had remarkable improvement without severe side effects. The general muscle strength was improved, and myasthenic crisis and thymoma had no reoccurence. Two patients with malignant thymoma were widely infiltrated in mediastinum and reoccurence,metastasis and myasthenic crisis occurred after operation. After a second resection and combined chemotherapy, 1 recovered to work and 1 retired to live on a normal life. Conclusion:Combined chemotherapy is effective for refractory MGMT.