胸腺切除治疗重症肌无力围手术期处理

Perioperative management of thymectomy for myasthenia gravis

目的 总结重症肌无力胸腺切除的围手术期处理经验。方法 回顾分析我科 1978年至 2 0 0 3年 5月所行胸腺切除治疗重症肌无力 2 43例病人术前准备 ,术中处理及肌无力危象的预防及处理。结果 2 43例术后发生肺部并发症15例 (肺部感染 6例 ,肺不张 5例 ,急性呼吸窘迫综合征 4例 ) ,危象 44例 ,占 18.1%,术后死亡 3例 (1.2 %)。结论 加强围手术期处理、预防及正确处理术后危象是保证手术安全 。

Objective To summarize the experiences in perioperative management of thymectomy for myasthenia gravis (MG). Methods The preoperative preparation, intraoperative management, and the prevention and management of postoperative myasthenic crisis in 243 patients undergoing thymectomy for MG in our department from 1978 to May 2003 were analyzed retrospectively. Results Pulmonary complications were found in 15 cases (6.2% including pulmonary infection in 6 cases, atelectasis in 5 cases, and acute respiratory distress syndrome in 4 cases), postoperative myasthenia crisis in 44 cases (18.1%), and postoperative death in 3 patients (1.2%). Conclusion Effective perioperative management and prevention and management of postoperative myasthenia crisis may be the key factor in ensuring operative safety and reducing mortality rate.