重症肌无力的外科治疗

目的：探讨重症肌无力的诊断及外科治疗经验。方法：回顾性分析1989年1月～2003年12月间经手术治疗的重症肌无力86例，其中单纯重症肌无力（MG）33例，胸腺瘤合并重症肌无力（TTMG）53例，正中纵劈胸骨切口82例，后外侧切口4例。结果：83例行完全切除，3例行大部切除，1例于肌无力危象期行手术治疗，78例术前、术后加用抗胆碱酯酶药物和（或）糖皮质激素，26例患者术后机械通气辅助呼吸，胸腺瘤术后病理分期Ⅱ期以上者进行放、化疗。术后随访6月至10年，30例缓解（34．88％），41例改善或明显改善（47．67％），8例无改善（9．30％），总有效率91．86％，5例恶化，2例术后半年内爆发重症肌无力危象死亡。结论：手术是治疗重症肌无力的重要手段，纵劈胸骨切口可以在较好的显露下行全胸腺切除加纵隔脂肪清除术；而抗胆碱酯酶药物及激素的使用是围手术期处理的关键，术后应注意机械通气的应用。处于肌无力危象期的患者抓好围手术期处理可行手术治疗。

Surgical treatment of myasthenia gravis(86 cases report)

Objective:To review the experience of diagnosis and surgical treatment of myasthenia gravis in 86 cases.(Methods:86 )patients with myasthenia gravis were operated on from January 1989 to December 2003 in our department. According Osseman clinical classification :stage in 19 cases, stage a in 27 cases, stageb in 25 cases,stage in 14 cases,stage in 1 cases.53 cases accompanied with thymoma in this group. Results:Total excision in 83 cases, partial excision in 3 cases,1 case was operated during myasthenic crisis period, anticholinesterase and glucocorticoid were used in 78 patients during preoperative and postoperative period,26 patients needed temporary mechanical ventilation,and patients with thymoma beyond stage recieved postoperative radiotherapy or chemotherapy. 2 case died of myasthenic crisis 6 months after operation. Conclusion:At present, surgical resection is the main therapeutic method for myasthenia gravis. The preferred surgical approach is through median sternotomy with resection of thymoma and perithymic fats in anterior mediastinum. anticholinesterase and glucocorticoid being used during preoperative and postoperative period remains in a key position.Some patients need temporary mechanical ventilation. Patients can be operated on during myasthenic crisis period. [