胸腺切除术治疗重症肌无力150例的疗效  

THERAPEUTIC EFFECT OF THYMECTOMY FOR 150 CASES WITH MYASTHENIA GRAVIS

作　　者：姚亚其[1] 庞烈文[1] 毛履琰[1] 

机构地区：[1]上海医科大学华山医院胸外科

出　　处：《上海医科大学学报》1998年第3期197-199,共3页Journal of Fudan University(Medical Science)

摘　　要：目的探讨胸腺切除术的适应证及其术后的处理要点，初评手术在治疗重症肌无力中的地位。方法对１５０例因重症肌无力而接受胸腺切除术患者的病史回顾和１～７ａ的随访。结果１５０例患者住院病死率为０，术后主要并发症为痰堵，有１８例作了气管切开术。其中术后单用抗胆碱酯酶药物者９例，使用皮质激素者９例，术后７ａ随访表明Ⅱ型重症肌无力、胸腺增生患者的手术效果更为满意。结论术后积极使用皮质激素，减少抗胆碱酯酶药物的使用，及时按需作气管切开术并加强呼吸道的管理，是手术后处理的关键。重症肌无力Ⅱ型或伴胸腺增生、胸腺瘤者为手术的适应证。手术与药物同为治疗重症肌无力的有效手段。URPOSE To discuss the indication and postoperative management of thymectomy for myasthenia gravis, and to evaluate the role of thymectomy in treating myasthenia gravis.METHODS 150 cases of myasthenia gravis who underwent thymectomy were reviewed. Results of sevenyear follow up were summerized.RESULTS There was no hospital mortality. The main postoperative complication was obstruction of the airway by sputum. Tracheostomy was done for 18 patients who recovered laterly. Among them, 9 were treated with anticholinoesterase only, and 9 treated with adrenocorticoid. The followup showed a satisfactory posto￣perative outcome in tpye Ⅱ myasthenia patient or with thymus hyperplasia.CONCLUSIONS Agressive administration of cortical steroid, reduction of anticholinoesterase dosage, measures to keep the airway free of obstruction, including a tracheostomy in time are key factors to save the patient form postoperative crisis. Myasthenia of tpye Ⅱ, or with thymus hyperplasia or thymoma are strong indications for surgical intervention. Thymectomy is an effective treatment for myasthenia gravis.

关 键 词：重症肌无力 胸腺切除术 疗效 

分 类 号：R746.105[医药卫生—神经病学与精神病学]