32例重症肌无力伴胸腺瘤患者手术治疗疗效评价

背景与目的:重症肌无力是一种自身免疫性疾病,主要累及神经肌肉接头,约1/4的患者同时伴有胸腺瘤的发生,手术治疗无论对于重症肌无力或胸腺瘤这两种独立疾病都是十分有效的手段.为研究同时伴胸腺瘤的重症肌无力患者在手术治疗后的转归,我们回顾性分析我院手术治疗的伴胸腺瘤重症肌无力患者的临床资料和随访结果.方法:收集2001年1月至2006年12月手术治疗的32例胸腺瘤合并重症肌无力患者的临床资料并进行随访,观察胸腺瘤复发情况和重症肌无力术后转归,并对患者年龄、性别、病理类型和重症肌无力严重程度等因素进行分析.结果:围术期死亡1例,随访期内胸腺瘤复发1例,30例患者在随访期内(14～61个月)没有出现肿瘤复发;术后7例患者重症肌无力达到完全缓解,13例达到部分缓解,9例维持稳定,2例病情加重,总有效率为64.5%.具有不同年龄、性别、病理类型和重症肌无力严重程度等因素的患者之间,有效率的差异均无显著性(P＜0.05).结论:胸腺瘤合并重症肌无力患者手术治疗应当尽可能完整切除肿瘤、胸腺组织及周围脂肪组织,术后对侵袭性肿瘤患者进行放疗,对肿瘤复发患者可以实行再次手术切除,术后重症肌无力可以得到不同程度的缓解.     

胸腺瘤外科治疗38例分析

本文分析手术治疗胸腺瘤３８例，其中良性２５例、恶性１３例，合并重症肌无力１１例。术后并发重症肌无力危象６例。结果表明：单纯良性胸腺瘤手术效果好，恶性者手术切除率低，单纯手术疗效差，但术后加放射治疗效果较满意。肿瘤及胸腺的广泛切除对重症肌无力效果不肯定，术后易并发重症肌无力危象。本文还探讨了短期应用较大剂量糖皮质激素在预防和治疗重症肌无力危象中的重要作用。     

重症肌无力合并胸腺瘤的手术治疗

目的总结重症肌无力合并胸腺瘤的围手术期处理方法及手术治疗效果。方法分析1994年9月~2004年1月接受手术治疗的42例重症肌无力合并胸腺瘤患者的临床资料。按改良Osserman标准分为Ⅰ型11例、Ⅱa型9例、Ⅱb型19例、Ⅲ型3例。随访结果按完全缓解、部分缓解、无效进行评价。结果42例无手术死亡,4例术后早期发生MG危象,经气管切开、辅助呼吸等抢救治疗痊愈。随访40例,手术后重症肌无力症状完全缓解18例,部分缓解率20例,无效2例。1例术后1年死于肿瘤复发并肺转移。结论完善围术期管理,减少MG危象的发生,手术治疗重症肌无力合并胸腺瘤可获得良好的疗效。     

恶性胸腺瘤的外科治疗(附28例分析)

恶性胸腺瘤多无特殊临床表现。传统的病理诊断对胸腺瘤良、恶性鉴别帮助不大，而术中检查肿瘤包膜是否完整，是否向周围组织、器官侵犯可为良恶性判断提供重要依据。恶性胸腺瘤均予术后放疗以提高生存率。本组28例恶性胸腺瘤外科治疗经验，其中7例合并重症肌无力，占25％。术后5年，10年生存率分别为63．2％和40％，生存率和分期相关（P＜0．05）。我们认为Masaoka分期法是一种较实用的分期法，其分期情况对指导术后治疗和判断予后有重要参考价值。手术切除虽是胸腺瘤首选治疗，但对于术中发现肿块和大血管关系密切，手术危险性极大时，要行姑息性切除，术后放疗仍可有较好疗效。对于合并重症肌无力者，强调经胸骨正中切口，以达到彻底切除胸腺及全部脂肪组织的目的。     

合并重症肌无力的胸腺肿瘤26例病理分析

目的：分析合并重症肌无力的胸腺肿瘤病理类型及手术后重症肌无力(MG)的治疗效果。方法：回顾性分析1994—2001年手术治疗的合并MG的胸腺肿瘤26例的临床资料。结果：胸腺瘤19例，胸腺脂肪瘤6例，胸腺鳞癌1例。手术切除肿瘤后，对MG的治疗有效率为84．6％，无效15．4％。结论：胸腺肿瘤伴有MG的患者，手术切除肿瘤是其有效的治疗手段。     

胸腺瘤合并重症肌无力的外科治疗

目的 探讨胸腺瘤合并重症肌无力(MG)的手术疗效。方法 观察分析近10年50例胸腺瘤合并重症肌无力手术患者病理分型、分期及重症肌无力临床分型的关系，手术方式和围手术期处理方法。结果 完整切除肿瘤38例，肿瘤大部分切除10例，仅作活检者2例。术后发生肌无力危象12例(24.0％)。胸腺瘤合并MG以上皮细胞型为主，Osserman分型以ⅡbⅢ型为主，肌无力危象发生率较高；其次为上皮淋巴细胞型，症状相对比上皮细胞型轻，多以I型、Ⅱb型为主，亦有肌无力危象发生。术后MG症状缓解42例(84.0％)。结论 手术是治疗胸腺肿瘤合并MG的主要方法，手术切除效果及预后与肿瘤的临床分期、手术切除范围、病理类型、病理分期等因素有关，围手术期处理是否恰当直接影响手术的安全。     

胸腺瘤168例临床资料分析

目的 探讨胸腺瘤的临床特点、治疗及预后。方法 回顾性分析本院收治的168例胸腺瘤并结合文献对其诊治进行讨论。结果 肿瘤完整切除126例，姑息切除29例，探查活检13例。术后并发肌无力危象7例，其中2例死亡。本组5年生存率为69．1％。结论 恶性胸腺瘤诊断后应尽早手术治疗；预后取决于肿瘤是否外侵及手术的彻底性，术后放疗、化疗有助于改善预后；手术治疗原则是即使不能完整切除也应尽可能多地切除肿瘤，复发的胸腺瘤仍有手术指征。     

电视胸腔镜胸腺瘤切除术

目的总结电视胸腔镜腺瘤切除术的临床经验。方法自2003年9月～2007年12月,我院胸腔镜手术治疗胸腺瘤22例。术后病理为良、恶性胸腺瘤和畸胎瘤。结果手术时间平均为122分钟,术中平均出血50ml,术后平均放置胸管时间48小时,平均住院时间5天。平均随诊2．5年,无肿瘤复发。结论胸腔镜治疗胸腺瘤和重症肌无力的短期随诊疗效满意。     

恶性胸腺瘤的外科治疗

恶性胸腺瘤多无特殊临床表现。传统的病理诊断对胸腺瘤良、恶性鉴别帮助不大，而术中检查肿瘤包膜是否完整是否向周围组织、器官侵犯可良恶性判断提供重要依据。恶性胸腺瘤均予术后放疗以提高生存率。本组２８例恶性胸腺癌外科治疗经验，其中７例合并重症肌无力，占２５％。术后５年，１０年生存率分别为６３．２％和４０％，生存率和分期相关，我们认为Ｍａｓａｏｋａ分期法是一种实实用的分期法，其分期情况对指导术后治疗和判断予     

手术联合（125）I粒子术中植入治疗12例恶性胸腺瘤近期疗效

[目的]探讨手术联合125I粒子植入在恶性胸腺瘤综合治疗的应用价值。[方法]回顾性分析2003年1月至2010年12月在手术姑息切除同时进行125I粒子植入治疗12例恶性胸腺瘤患者临床资料,观察并发症,评价肿瘤变化及复发转移。[结果]术后粒子分布满意率66.7%,并发咯血2例,粒子移位4例。12例患者随访9个月～7年,术后出现肌无力危象呼吸衰竭1例,局部复发转移3例,死亡4例。[结论]手术联合125I粒子术中植入治疗无法手术根治的恶性胸腺瘤,可以提高手术疗效,降低局部复发率。     

Diagnosis and surgical treatment of primary mediastinal tumors

This paper presents the diagnosis and surgical treatment of 60 patients with mediastinal tumors proven by pathology. The pathological types were: 36.7% teratodermoid tumor, 33.3% thymoma, 10% mediastinal cyst, 8.3% neurogenic tumor, 5% intrathoracic goiter and 6.7% other rare tumors. Fourty two of the 44 patients with benign tumors underwent resection. Of the 16 patients with malignant tumors, only 7 had the tumor removed, and the rest 9 were given exploration and biopsy. The majority of teratodermoid tumors was benign but perforation and infection added the difficulties to operation. The most common complication of thymoma was myasthenia gravis which comprised 35% in this study. The relation between thymoma and myasthenia gravis is intricate. The benign thymoma was much better in the resectability and survival rate than the malignant thymoma. Finally, the differential diagnosis between the benign and malignant thymomas is discussed. A rare case of malignant thymoma complicated by hypertrophic osteoarthropathy is reported in detail.     

Diagnosis and therapy of thymoma

In the postoperative diagnosis of thymoma, the most important problem over the last 30 years has been whether the condition is benign or malignant. In this paper, we discussed the diagnosis of thymoma malignancy and its therapy based on our own experiences. All thymomas have the potential to be malignant. Some thymomas have low malignancy and others high malignancy. As the malignancy is therefore not uniform, it is impossible to divide thymomas into either benign or malignant categories. Masaoka, one of the present authors, introduced the concept of clinical stage to thymoma. We think that the difference between invasive and noninvasive thymomas is due to differences in the clinical stage. We also proposed a new classification of thymomas based on the degree of epithelial differentiation. This new classification reflects the malignancy of the thymoma. Both the clinical stage classification and the classification based on epithelial differentiation showed good correlations with the prognosis of thymoma can be surmised by an exact diagnosis based on these two new classifications. The most important point concerning the therapy of thymoma is radical resection of the tumor. However, reduction surgery can be the method of second choice, especially in myasthenic thymoma, because of its slow growth. We carried out irradiation in all patients with thymoma postoperatively, resulting in a low rate of recurrence of the thymoma. This indicates the effectiveness of radiation therapy for this condition.     

Cystic thymomas. A clinicopathologic study of ten cases.

Cystic degeneration in thymoma is a relatively frequent but focal event. In rare cases, the process proceeds to the extent that most or all of the lesion becomes cystic. The authors studied ten cases of thymoma undergoing cystic degeneration of such degree that the lesions initially were mistaken grossly and microscopically for nonneoplastic thymic cysts. The patients' ages ranged from 23 to 81 years, and the sex distribution was equal. The lesions were characterized by the formation of multiple large cystic cavities filled with clear, hemorrhagic or grumose material. Histologically, residual solid islands showing the characteristic features of thymoma, i.e., biphasic cell population (epithelial cells/lymphocytes), perivascular spaces, and areas of medullary differentiation, were present within the cyst walls. In contrast with nonneoplastic thymic cysts, the walls of the cavities generally were devoid of an epithelial lining; most of the cysts appeared to predominantly result from extreme dilatation and confluence of perivascular spaces. In some instances, the cystic degeneration of the tumor was accompanied by cystic changes of an inflammatory nature in the surrounding, nonneoplastic thymic tissue leading to firm adhesions and apparent infiltration of adjacent mediastinal structures. None of the lesions in the studied patients recurred during follow-up periods of from 2 to 10 years (average follow-up, 5 years). Cystic thymomas should be distinguished from nonneoplastic congenital and acquired thymic cysts and other primary thymic neoplasms undergoing extensive cystic degeneration. It is important not to misinterpret the apparent infiltration of surrounding mediastinal structures that results from the inflammatory changes that often accompany these tumors as evidence of aggressive or malignant behavior.     

Aberrant methylation: common in thymic carcinomas, rare in thymomas

Thymic carcinoma, which is a rare epithelial neoplasm of the thymus gland, is different from thymoma in its clinical and pathological features. To clarify the mechanism underlying the aggressive behavior of thymic carcinoma, we examined the clinicopathologic features, aberrant methylation patterns of the tumor suppressor genes, and epidermal growth factor receptor (EGFRs) mutation in both thymic carcinomas and thymomas. Clinical data of 11 thymic cancers and 13 thymomas were reviewed. Resected samples of 5 thymic cancers and 6 thymomas selected from 24 cases were used for methylation and mutation studies. Positive tumor markers were more frequent in thymic cancers than in thymomas (p=0.0233), and the methylation index, which reflects the overall methylation pattern, was significantly higher in thymic carcinomas (p=0.0053). No tumors showed a mutation of EGFR, KRAS, and HER2. Thymic carcinoma is distinct from thymoma not only with respect to clinicopathological features, but also aberrant methylation patterns of the tumor suppressor genes.     

Two cases of malignant thymoma presenting as an anterior neck mass and misdiagnosed as thyroid carcinoma

Two cases of malignant thymoma presenting as an anterior neck mass are reported. Both tumors were initially diagnosed as thyroid carcinoma. The lesions were not ectopic thymomas and had invaded the thyroid gland from the mediastinum. Careful preoperative examination is important to distinguish thyroid cancer from invasive thymoma. Received: December 17, 1997 / Accepted: October 15, 1998     

Pericardial involvement by thymomas

Thymomas are usually found in the anterior mediastinum, the normal location of the thymus. Involvement of the pericardium by thymic tumors is seen in invasive or metastasized thymoma. Very rarely, thymomas arise primarily in the pericardium. These tumors are believed to derive from thymic tissue which was misplaced in the pericardium during embryologic development. In contrast to patients with orthotopic thymoma who commonly suffer from paraneoplastic diseases, especially myasthenia gravis, patients with intrapericardial thymoma manifestations mainly have symptoms of congestive heart failure which are caused by local complications of tumor growth. In this study, we present two cases of thymoma involving the pericardium. Both tumors were polygonal-oval cell thymomas. In one of the cases diagnosis of an entirely intrapericardial thymoma was established by autopsy. In the other case, explorative thoracotomy revealed massive pericardial and pleural tumor manifestations. The latter tumor showed a peculiar histological pattern with multiple glomeruloid bodies, a finding reported only once for thymomas.     

Kraske术在直肠肿瘤保肛治疗中的应用

目的探讨改良Kraske经骶尾后入路手术在中低位直肠肿瘤保肛治疗中的应用及其适应证。方法回顾性分析江苏省肿瘤医院普外科结直肠外科1997年11月~2005年11月应用该手术方法治疗的31例中低位直肠良恶性肿瘤的临床资料。结果全组31例患者中,直肠腺癌14例,直肠类癌5例,直肠间质瘤1例,直肠腺瘤9例,增生性息肉2例。所有患者手术过程均顺利,无肛门失禁病例。3例并发粪瘘(3/31,9.6%),其中2例于术后1个月痊愈,1例术后2周再次行横结肠袢式双腔造瘘术。2例直肠腺瘤患者术后1年出现复发(2/31,6.5%),1例追加Parks术,1例再次经肛局部扩大切除。14例直肠腺癌,T1期9例,T2期5例,无局部复发,总的5年生存率为90%。5例直肠类癌的5年生存率为100%。1例间质瘤目前生存3年。结论改良的经骶尾后入路Kraske术为直肠中下段的各种良性和选择性的恶性肿瘤的保肛手术提供了1个安全、有效、易操作和患者易耐受的手术方式。     

Chemotherapy in invasive thymomas: five case reports

We treated 5 cases of invasive thymomas with single agent and combination chemotherapy. A carcinoid tumor of the thymus had a 13-month objective response to monthly courses of a combination of DTIC, adriamycin, cytoxan, and vincristine. A second case of carcinoid achieved stabilization of disease with a combination of adriamycin, cyclophosphamide, and DTIC for 9 months and subsequently 10 months, with fluorouracil and methotrexate. A case of thymoma had stabilization of disease for 14 months with oral cytoxan and prednisone.     

心脏肿瘤30例临床病理分析

目的：分析30例心脏肿瘤的病理类型、形态学变化及其临床病理特征。方法：采用HE染色、组化及免疫组化SP技术对30例心脏肿瘤进行病理学观察。结果：良性肿瘤25例(83％)，包括心房粘液瘤、心脏横纹肌粘液瘤、心包囊肿；恶性肿瘤5例(17％)，包括血管内皮肉瘤、恶性间皮瘤、恶性淋巴瘤、心包恶性胸腺瘤及转移癌。结论：心脏肿瘤以原发性较多见。而原发性心脏良性肿瘤以心房粘液瘤最多见，其他少见，原发性心脏恶性肿瘤类型较多，组织学形态较复杂，易与继发性肿瘤混淆。选择适当的影像学检查，有效的心脏外科手术、配合以病理形态学观察及免疫组化标记，对原发性心脏肿瘤的诊治很有必要。     

The distribution of epithelial membrane antigen in thymic epithelial neoplasms.

Thymic carcinomas arising within a thymoma have been reported, but the relationship between thymoma and thymic carcinoma is poorly understood. Epithelial membrane antigen (EMA) is known to be an effective marker for establishing the epithelial nature of neoplastic cells, and it is reported that staining of tumors is clearly related to the degree of tumor differentiation. Eighty-one thymomas (59 noninvasive, 22 invasive) and 14 thymic carcinomas were studied immunohistologically using antiepithelial membrane antigen (anti-EMA) monoclonal antibody. Thymic carcinomas tended to express much larger quantities of EMA than thymomas, and instances of EMA-positive thymoma were seen significantly more often in invasive thymomas than in noninvasive ones (P < 0.05). However, EMA positivity was also associated with gland-like structures, which were not necessarily associated with malignant disease. Nevertheless, in view of the concept that thymoma and thymic carcinoma show a similar cellular differentiation, EMA-positive epithelial cells in thymoma with no relation to gland-like configurations might represent a pool of cells having a latent potential for malignant disease and might be transformed into thymic carcinoma cells under certain conditions. Immunolabeling for EMA appears to be a useful tool for determining the degree of malignant disease among thymic epithelial neoplasms.