胸腺瘤并重症肌无力的手术及围术期治疗的临床研究

目的：研究胸腺瘤并重症肌无力外科治疗的手术方法、围术期处理及疗效。方法：研究分析15例胸腺瘤并重症肌无力患者的手术、围术期治疗及术后随访结果。结果：本组无围术期死亡，除2例发生重症肌无力危象外，其余恢复顺利。术后随访发现症状完全缓解8例，改善7例。结论：胸腺瘤并重症肌无力病人术前通过抗胆碱酯酶药物及肾上腺皮质激素的应用，应使病人能维持正常的生理活动；术前插胃管，于麻醉前、术中、术后早期鼻饲给药；胸骨正中切口能充分显露前纵隔结构，清除彻底，术中对瘤体周围的可疑组织(包括脂肪组织)按瘤体组织处理，必要时电灼灭活，术毕顺铂冲洗；麻醉要求相对较高，带咽气管插管或气管插管回病房可防止早期重症肌无力危象引起的呼吸道梗阻；大剂量甲基强的松龙(1000mg/日)肌注及气管插管机械辅助通气是抢救重症肌无力危象成功的关键。

A clinical study of surgical operation and perioperative treatment of thymomas with myasthenia gravis

Objective:To study the technique of surgical operation, perioperative treatment and therapetutic effect of thymomas with myasthenia gravis. Method:15 cases of thymomas with myasthenia gravis treated by surgical operation were analyzed retrospectively. Results: Of 15 cases ,there was no perioperative mortality ,all the cases recovered quickly except 2 cases with myasthenic crisis.After the follow up ,8 cases had completely remmission and 7 cases with symptomatic improvement.Conclusion: Intensive perioperative management is the key to the treatment of thymomas with myasthenia gravis.Anticholinergics and corticosteroids are used to maintain the patient's natural physiological activity before the operation . Depth anesthesia is necessary , postoperative upper airway obstruction due to myasthenic crisis can be prevented by acheal intubation. To facilitatetr nasogastric tube is used to take drugs preoperative period and during operation . Anterior mediastinal fat and soft tissues can be exposured sufficiently by taking median strnotomies , thymoma and uncertain tissue need be quited rexect. Overdosage methylprednisolone(1000mg/d) and machine-assisted aerate is necessary for the treatment of myasthenic crisis.