重症肌无力胸腺瘤手术及围术期临床研究

目的：探讨胸腺瘤合并重症肌无力（MG）患者胸腺瘤的手术方法、围术期的处理和治疗效果。方法：回顾分析本院86例胸腺瘤伴MG患者临床资料，包括手术前准备、术中处理、术后危象的预防及处理等。结果：手术86例术后发生肌无力危象（MGC）共16例（18．60％），除术后死亡2例外，其余病例恢复出院。术后肌无力症状完全缓解42例、改善30例，有效率83．72％，其余14例症状无缓解或加重。结论：胸腺瘤切除是治疗胸腺瘤合并重症肌无力的一种较安全而有效方法。术前充分准备，术中彻底切除胸腺瘤及前纵隔淋巴结脂肪组织．术后延长呼吸机辅助通气，合理及时使用胆碱酶抑制剂及激素，加强呼吸道管理控制感染等综合措施，是预防及治疗肌无力危象的有效方法．有利于降低MGC发生率及围术期死亡率。

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: 86 cases of thymomas with myasthenia gravis were treated by surgical operation.The preoperative preparation,operative management,prevention and treatment of postoperative myasthenia gravis were analyzed retrospectively.Results: Of 86 cases,there was postoperative myasthenia gravis crisis in 16 cases(18.6%).All the cases recovered quickly except 2 cases who died after operation.After the follow up,there were 42 cases with complete remission and 30 cases with symptomatic improvement.(effective rate=83.72%).The other 14 cases showed no relief.Conclusion: Thymectomy for thymomas with myasthenia gravis is safe and effective.Complete resection of anterior mediastinal fat,lymph node and thymomas must be emphasized.In order to reduce the postoperative complication and operative mortality,intensive perioperative management is the key to for the thymomas with myasthenia gravis,including artificial ventilation,prompt use of anticholinergics and corticosteroids,enhancing the control of respiratory infection.