摘要
目的 研究胸腺瘤伴重症肌无力患者的围手术期治疗。方法 自１９９１年７月至１９９８年７月，手术治疗胸腺瘤伴重症肌无力患者６例，占同期收治胸腺瘤患者的２７．３％ 。结果 Ｍａｓａｏｋａ Ⅰ期、Ⅱ期、Ⅳ期各１ 例，Ⅲ期３ 例。无手术死亡。术后１ 例１个月后死于呼吸衰竭，１ 例２ ａ后死于肿瘤复发。生存４ 例，３ 例治愈，１ 例好转。结论 认为胸部Ｘ线检查是诊断本病的重要方法。其良恶性的判断主要依靠术中所见肿瘤的生长方式及组织细胞学类型。加强围手术期处理，是降低手术并发症及死亡率的关键。强调合理使用抗胆碱酯酶药物；采用低位胸部正中切口，尽可能切除肿瘤，清扫前纵隔；尽早拔除气管内插管；选用有效抗生素防治肺部感染，以降低肌无力危象的发生率。
Objective\ To study the perioperative treatment of thymomas with myasthenia gravis. Methods\ From July 1991 to July 1998, six patients of thymoma with myasthenia gravis were operated on, accounting for 27 3% of all treated thymoma patients. Results\ According to Masaoka classification. All of 4 types were present, 3 of the 6 cases belonged to type Ⅲ. There was no operative mortality. Postoperatively, one patient died of respiratory failure one month after operation, and one died of recurrance of thymoma two years later. The survived four patients had complete remission in three cases and one with symptomatic improvement. Conclusion\ Chest X ray examination is important in diagnosis. Distinction between benign and malignant thymomas is mainly based on gross invasion observed at surgery and histologic and cytologic features of the thymoma. To reduce operative morbidity and mortality intensive perioperative management is the key, which includs: (1)Using anticholinesterase agents rationally; (2)Taking lower median sternotomies and radical resections of the thymoma and all anterior mediastinal fat and soft tissues; (3)Removing intratracheal catheters as early as possible; and (4)Using effective antibiotics to prevent and treat pulmonary infections so as to reduce the myasthenic crisis.
出处
《南京医科大学学报（自然科学版）》
CAS
CSCD
1999年第6期479-481,共3页
Journal of Nanjing Medical University(Natural Sciences)
