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目的为提高胸腺瘤(或增生)合并重症肌无力(MG)患者手术的安全性和治愈率总结其临床治疗经验。方法回顾性分析58例胸腺瘤合并MG患者的临床资料;改良Osserman法分型:Ⅰ型30例,Ⅱa型18例,Ⅱb型7例,Ⅲ型3例。术前均给予肾上腺糖皮质激素和抗胆碱酯酶药物治疗,病情稳定后行胸腺扩大切除术。结果全组病例无手术死亡,对发生MG危象的12例患者予以气管内插管或气管切开,必要时使用呼吸机辅助呼吸,经处理后痊愈。结论扩大胸腺切除术是治疗胸腺瘤(或增生)合并重症肌无力的有效手段,加强围术期处理及其长期综合治疗是提高疗效的关键。
Objective To improve the safety and cure rate of thymoma (or hyperplasia) in patients with myasthenia gravis (MG) and summarize its clinical experience. Methods The clinical data of 58 patients with thymoma and MG were analyzed retrospectively. The modified Osserman method included 30 cases of type Ⅰ, 18 cases of type Ⅱa, 7 cases of type Ⅱ b and 3 cases of type Ⅲ. Preoperative adrenal glucocorticoid and anticholinesterase drugs were given, the condition was stable after thymus enlargement resection. Results There was no operative death in all the cases. Twelve patients with MG crisis were treated by endotracheal intubation or tracheotomy. When necessary, the ventilator was used to assist breathing and healed after treatment. Conclusions Expansion of thymus resection is an effective method for the treatment of thymoma (or hyperplasia) with myasthenia gravis. Strengthening perioperative management and long-term comprehensive treatment are the keys to improve the curative effect.