胸腺瘤手术后早期新发重症肌无力的误诊分析

Misdiagnosis analysis of early new myasthenia gravis after thymectomy

目的探讨胸腺瘤切除术后早期新发重症肌无力(myasthenia gravis,MG)的误诊原因及防治措施。方法对2013 01—2018 12河南中医药大学第一附属医院心胸外科行胸腺瘤切除术,且术后早期出现新发的4例MG患者的临床资料进行回顾性分析。结果 4例患者术前均不存在肌无力症状,行胸部影像学检查时发现胸腺瘤,胸腺瘤切除术后早期均出现不典型肌无力症状,但未能及时明确诊断。随着肌无力症状快速进展,出现四肢无力、严重呼吸困难等MG症状,行新斯的明试验阳性,明确诊断,积极治疗,4例病情缓解均顺利出院。结论胸腺瘤切除术后早期新发MG的初起表现缺乏特异性,易与一些术后常见并发症相混淆,延误诊断及治疗。对于术前单纯胸腺瘤患者,仍需考虑到术后早期合并新发MG的可能。

Objective To discuss the causes of misdiagnosis and preventive measures of early new MG after thymectomy. Methods The clinical data of 4 cases of thymectomy in our department from January 2013 to December 2018 were retrospectively analyzed,all of them were early new MG after thymectomy. Results There were no myasthenia symptoms in 4 patients before operation.Thymoma was found by imaging examination.Atypical symptoms of myasthenia appeared early after thymectomy.Failure to make a definite diagnosis in time.With the rapid development of myasthenia symptoms,MG symptoms such as limb weakness and severe dyspnea were appeared,confirmed MG by Neostigmine test positive.All 4 cases were discharged after remission by active treatment. Conclusion The initial onset of new MG after thymoma resection is lack of specificity,which is easily confused with some common postoperative complications,delay diagnosis and treatment.For patients with preoperative simple thymoma,it is still necessary to consider the possibility of combining new MG in the early postoperative period.