12例胸腺瘤伴重症肌无力围手术期治疗临床分析

Retrospective analysis of perioperative treatment of 12 patients with thymoma and myasthenia gravis

目的 探讨胸腺瘤伴重症肌无力的围手术期治疗方法。方法 自 1991 年 12 月至2002年 12 月,手术治疗胸腺瘤伴重症肌无力病人 12 例,占同期手术治疗胸腺瘤病人的 28 .4%。OssermanⅠ、Ⅲ型各2例,Ⅱa型 5 例,Ⅱb型 3 例。结果 术后 2 例分别于 1、6 个月后死于肺部感染、呼吸衰竭,1例2年后死于肿瘤复发。9例存活,其中 7 例治愈,2 例好转。结论 降低手术并发症及死亡率的关键:(1)合理使用抗胆碱酯酶药物和激素;(2)采用低位胸部正中切口,彻底切除肿瘤及清扫前纵隔;(3)尽早拔除气管插管,选用有效抗生素防治肺部感染;(4)必要时气管切开、呼吸机辅助呼吸。

Objective To analyse the perioperative treatment of patients with thymoma and myasthenia gravis retrospectively.Methods From December 1991 to December 2002,12 patients with thymoma and myasthenia gravis were operated on,accounting for 28.4% of all treated thymoma patients.According to Osserman classification,2 patients were type Ⅰ,5 type Ⅱa, 3 type Ⅱb and 2 type Ⅲ.Results Two patients died of lung infection and respiratory failure one and six months after the operations respectively, and one case died of recurrance of thymoma two years after operation.The survived 9 patients had complete remission in 7 patients and symptomatic improvement in 2. Conclusion In order to reduce the operative morbility and mortality,intensive perioperative management is the key,including using anticholinesterase agents rationally,taking lower median sternotomy and resecting the thymoma and all the fat and soft tissues in the anterior mediastinum,extubation as early as possible after operation,and using effective antibiotics to prevent and treat pulmonary infections. [