重症肌无力胸腺瘤的围术期处理

目的总结重症肌无力（myasthenia gravis,MG）胸腺瘤的围术期处理经验。方法回顾分析本科1990年7月～2008年6月连续手术治疗胸腺瘤合并MG65例患者的临床资料。结果危象预测积分〈12分者,无危象发生;12～17分者危象发生率50.0%;18～23分者危象发生率71.4%;≥24分者危象发生率75.0%。术前危象预测积分≥12分者,术后24h拔除气管插管和气管切开的患者分别为85.7%和61.4%,显著高于危象预测积分〈12分者的20.5%和6.8%。术后肌无力症状完全缓解23例、改善25例,有效率85.7%,改善不明显或加重8例。结论胸腺瘤切除是治疗重症肌无力胸腺瘤的一种较安全而有效的方法。围手术期治疗的重点是防治MG危象。

Treatment of the myasthenia gravis (myasthenia gravis,MG) thymoma in peroperative period

Objective To summarize the experience of treatment of the myasthenia gravis（myasthenia gravis,MG） thymoma in peroperative period.Methods Retrospective analysis of clinical data of 65 cases with thymoma and MG who were undertaken continuous surgical treatment in our department from July 1990 to June 2008.Results Crisis predicted points 12 points,there was no crisis occurred;the incidence rate of crisis of 12 ～ 17 points was 50.0% ;the incidence rate of crisis of 18 ～ 23 points was 71.4% ;the incidence rate of crisis of ≥24 points patients was 75.0%.Preoperative crisis prediction points ≥12 points,24 h after postoperation the rate of patients who suffered extubation and tracheostomy were 85.7% and 61.4%,respectively,Preoperative crisis prediction points 12 points,the rate were 20.5% and 6.8%,respectively.Postoperation there were 23 cases whose symptoms of MG was complete remission,25 cases improved,the efficiency was 85.7%,8 cases had no obvious improvement or aggravation.Conclusion Thymoma resection is a relatively safe and effective method in treating myasthenia gravis with thymoma.The treatment in peroperative period focuse on prevention and cure of the MG crisis.