扩大胸腺切除治疗重症肌无力30例报告

目的:探讨重症肌无力的外科治疗和围手术期处理。方法:30例患者均采用胸骨正中切口,术中完全切除胸腺组织,同时彻底清除前纵隔脂肪组织,术前后应用抗胆碱酯酶药物和肾上腺皮质激素,出现肌无力危象者予气管插管呼吸机辅助呼吸,加强抗感染治疗和营养支持治疗。结果:术后2例出现肌无力危象,经抢救好转,余均恢复顺利,术后随访5个月~5年,症状完全缓解14例,改善11例,无效2例,死亡3例。结论:胸骨正中切口行扩大胸腺切除术是治疗重症肌无力的有效方法,对重症肌无力病人应及早行手术治疗。

Report on 30 cases of myasthenia gravis treated by extended thymectomy

Objective:To study the surgical and perioperative treatment of patients with myasthenia gravis retrospectively.Methods: 30 patients with myasthenia gravis were undergone median sternotomy with total resection of thymoma and removal of all the fat and soft tissues in the anterior mediastinum.Articholinergics and corticosteroids were used to maintain the patient′s natural physiological activity in the preoperative and postoperative period.Postoperative upper airway obstruction due to myasthenic crisis were prevented by assisted respiratory supporter and antibiotics were included to prevent and treat pulmonary infections. (Results:) Of 30 cases,all the cases recovered quickly except 2 cases with myasthenic crisis.14 cases were found completely remission and 11 cases with symptomatic improvement,2 cases failure and 3 cases death during follow-up period of from 5 months to 5 years.Conclusion: Extended thymectomy is an effective surgical procedure for patients with myasthenia gravis and it should be considered as early as possible.