58例胸腺瘤合并重症肌无力的围手术期处理

目的探讨胸腺瘤合并重症肌无力(MG)围手术期处理方法。方法回顾分析1970年6月至2007年6月接受手术治疗的58例胸腺瘤合并MG患者的临床资料,包括术前准备、手术路径及术后危象的预防及处理。结果本组发生术后肌无力危象21例,发生率36.2%。术后死亡5例。术后随访47例,肌无力症状消失19例,缓解15例,改善不明显或加重13例。结论术前充分准备,术中置胃管,术中经胸骨正中切口彻底切除胸腺瘤及前纵隔淋巴脂肪组织,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。

Perioperative management for 58 cases of thymoma with myasthenia gravis

Objective To investigate the experiences in the perioperative managements of myasthenia gravis(MG) associated with thymoma.Methods The data of 58 cases of myasthenia gravis(MG) associated with thymoma which underwent surgical treatment from June,1970 to June,2007 were analyzed retrospectively,including the preoperative preparation,operative approach and prevention and treatment of postoperative myasthenia gravis.Results Of 58 cases,postoperative MG crises were seen in 21 patients(36.2%).Postoperative mortality was 8.6%(5/58).In 47 cases of the post-operation follow up,there were 19 cases with complete remission,15 cases with symptomatic improvement and 13 cases with no improvement.Conclusion For crisis of myasthenia gravis,intensified perioperative management is very important to avoid and to reduce the postoperative complication and operative mortality,including preoperative preparation,nasogastric intubation during operation,complete resection of anterior mediastinal fat and thymomas by taking median sternotomies,prompt use of anticholinergies and adrenocorticoids and enhancing the control of respiratory infection.