围术期免疫针对性缓解治疗预防重症肌无力术后危象

目的 总结重症肌无力(MG)胸腺切除的围术期处理经验,探讨预防术后肌无力危象和呼吸道并发症的有效措施.方法 回顾性分析2003年1月至2006年12月间手术治疗58例全身型重症肌无力病人的临床特点、围术期处理、术后并发症及近期疗效,观察以糖皮质激素和免疫球蛋白为主的围术期免疫,针对性缓解治疗预防MG胸腺切除术后肌无力危象和其他呼吸道并发症的临床效果.结果 全组无手术死亡,手术后并发症3例(5.2%),无肌无力或胆碱能危象发生,无肺部感染、再次气管插管及气管切开病例.术后随访1个月至3年,完全缓解16例(27.6%),部分缓解37例(63.8%),无效5例(8.6%),总有效率91.4%.结论 围术期采用短程免疫针对性缓解治疗,规范手术操作,优化术中和术后早期处理,可以明显减少肌无力危象和术后并发症的发生率.

Prevention of postoperative myasthenic crisis after thymectomy by perioperative immune-directed remission therapy

Objective To evaluate the effect of perioperative immune-directed remission therapy in prevention of myasthenic crisis after thymectomy for general myasthenia gravis patients.Methods 58 patients with general myasthenia gravis who underwent thymectomy from January 2003 to December 2006 were reviewed.The remission induction therapy was conducted in all the patients preoperatively with immunoglobulin or in conjunction with high-dose glucocorticoid,and the remission was maintained by short term continuing infusion of immunoglobulin or slow tapering of corticosteroid postoperatively.Post operative myasthenic crisis and other respiratory complications were analyzed and the effectiveness of the operation was estimated by the remission rates at follow-up of 1 month to 3 years.Results There was no operative death,nor early post-operative myasthenic crisis or cholinergic crisis.No retintubation or tracheotomy was performed postoperatively.Complications related to extended thymectomy occurred in 3 patients (two cases of unilateral diaphragmatic paralysis and one Left recurrent laryngeal nerve paralysis).The total effective rates were 91.4%. Complete remission and partial remission were gained in 16 patients (27.6%) and 37 patients (63.8%) respectively.Conclusion Short-term perioperative immune-directed remission therapy could effectively prevented post-operative myasthenic crisis and respiratory complications in addition to standardized operative maneuver and optimized early postoperative management.