胸腺瘤切除术后的重症肌无力发生情况及影响因素

目的 分析胸腺瘤切除术后的重症肌无力发生情况及影响因素,旨在为临床预防术后重症肌无力提供参考依据。 方法 选取金华市中心医院2019年3月—2020年3月收治的92例胸腺瘤切除术患者,观察并记录术后重症肌无力的发生情况,统计发生率,并根据术后是否发生重症肌无力将患者分为重症肌无力组(A组,11例)与未发生重症肌无力者(B组,81例),收集2组患者的一般资料,整理临床资料,对比2组一般资料与临床资料的差异性,应用多因素logistic回归分析法分析术后发生重症肌无力的危险因素。 结果 92例患者术后发生重症肌无力11例,发生率为12.0%;2组患者的术前病程、合并免疫疾病、手术路径、合并前纵隔脂肪清扫术、术后肺部感染、术后放化疗情况对比,差异有统计学意义(均P<0.05);多因素logistic回归分析结果显示,术前病程(>12个月)、合并免疫疾病、手术路径(开胸)、术后肺部感染是术后发生重症肌无力的危险因素,合并前纵隔脂肪清扫术、术后放化疗是其保护因素。 结论 胸腺瘤切除术后的重症肌无力发生率较高,影响因素也较多,常见如术前病程长、合并免疫疾病、开胸手术、术后肺部感染等,因此行胸腺瘤切除术时应针对患者的危险因素采取对症处理措施,以降低重症肌无力发生率,提高手术治疗效果。 

Incidence and influencing factors of myasthenia gravis after thymectomy

Objective To analyze the incidence and influencing factors of myasthenia gravis after thymectomy, in order to provide reference for clinical prevention of myasthenia gravis. Methods Ninety-two patients with thymectomy in our hospital from March 2019 to March 2020 were selected to observe and record the incidence of myasthenia gravis after operation. The patients were divided into group A and group B according to whether myasthenia gravis occurred after operation. The general data of the two groups were collected by questionnaire survey, the clinical data were sorted out, and the general data and clinical data of the two groups were compared. The risk factors of myasthenia gravis were analyzed by logistic regression analysis. Results There were 11 cases of myasthenia gravis(12.0%) after operation in 92 patients. The course of disease, combined immune disease, operation route, combined anterior mediastinal fat dissection, postoperative pulmonary infection, postoperative radiotherapy and chemotherapy were compared between the two groups, and the difference was statistically significant(all P<0.05). The results of multivariate logistic regression analysis showed that the course of disease(>12 months), combined immune disease, surgical route(open chest) and postoperative pulmonary infection were the risk factors of myasthenia gravis, and the combined anterior mediastinal fat dissection, postoperative radiotherapy and chemotherapy were the protective factors. Conclusion The incidence of myasthenia gravis after thymectomy is relatively high, and there are many influencing factors, such as long course of disease, combined with immune diseases, thoracotomy, postoperative pulmonary infection, etc. Therefore, we should take symptomatic treatment measures according to the risk factors of patients during thymectomy to reduce the incidence of myasthenia gravis and improve the effect of surgery.