胸腺瘤的外科手术治疗

目的：总结胸腺瘤的外科手术治疗效果及预后。方法：回顾性分析1993年1月～2003年12月在我院外科手术治疗的146例胸腺瘤患者的临床资料。结果：全组手术切除率为97．3％（142／146），围术期死亡率4．1％（6／146）。随访135例，其中单纯胸腺瘤患者68例，1、3、5年生存率分别为94．1％（64／68）、86．6％（52／60）、77．1％（37／48）；胸腺瘤伴重症肌无力患者67例，1、3、5年生存率分别为100．0％（67／67）、92．7％（51／55）、85．7％（36／42），两者生存率比较差异无统计学意义（P〉0．05）。按Masaoka病理分期，患者5年生存率Ⅰ期96．8％（30／31）、Ⅱ期88．9％（32／36）、Ⅲ期55．0％（11／20）、Ⅳ期0（0／3）；其中Ⅰ、Ⅱ期5年生存率95．5％（62／67）高于Ⅲ、Ⅳ期5年生存率47．8％（11／23），差异有统计学意义（P〈0．01）。结论：治疗胸腺瘤以外科手术为主，Masaoka分期有助于手术指征的选择，并能有效的判断手术疗效及预后。

Surgical therapy for thymoma

Objective: To summarize efficacy and prognosis of thymoma surgery.Methods: Retrospectively analyzed 146 cases with thymoma surgery from Junuary 1993 to December 2003.Results: Resection rate was 97.3 %(142/146),perioperative mortality was 4.1 %(6/146).135 cases were followed up,including 68 cases with simple thymoma and 67 thymamo cases with myasthenia gravis.The 1,3,5-year survival rate of simple thymoma patients was 94.1 %(64/68),86.6%(52/60) and 77.1%(37/48) respectively,while 1,3,5-year survival rate of simple thymoma patients with myasthenia gravis was 100.0%(67/67),92.7%(51/55),85.7%(36/42) respectively,with insignificant difference between them(P<0.05).According to Masaoka pathological stage,the 5-year survival rate of stage Ⅰ,Ⅱ,Ⅲ,Ⅳ was 96.8%(30/31),88.9%(32/36),55.0%(11/20),0%(0/3) respectively.The 5-year survival rates of stageⅠandⅡwere significantly higher than stage Ⅲ and Ⅳ(92.5% vs 47.8%,P<0.05).Conclusion: Surgery is main therapy for thymoma.Masaoka pathological stage contributes to the choice of surgical indications,judgment of efficacy and prognosis.