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目的总结女性重症肌无力(MG)患者的外科治疗及围术期处理经验。方法回顾性分析1979年1月至2007年12月收治的186例(包括川北医学院附属医院胸心血管外科41例,南方医科大学附属南方医院胸心血管外科145例)MG女性患者的临床资料,年龄5~64岁,平均年龄43.9岁。按Osserman临床分型,小儿MG45例,成人MG141例,其中眼肌型25例,轻度全身型63例,中度全身型29例,急性暴发型19例,晚期严重型5例。合并胸腺瘤166例,按Masaoka分期I期40例,Ⅱ期69例,Ⅲ期44例,Ⅳ期13例。152例患者经胸骨正中切口径路手术,行胸腺切除,纵隔淋巴结清扫术;34例胸腺无明显增生经颈部横切口行单纯胸腺切除术。结果全组无手术死亡。围术期发生MG危象22例,经相应的处理治愈。术后随访12个月以上165例,失访21例。痊愈30例(18.18%)、基本痊愈28例(16.97%)、显效60例(36.36%)、好转25例(15.15%)、无效22例(13.33%)。Ⅰ型、Ⅱa型、Ⅱb型、Ⅲ型和Ⅳ型有效率分别为100.00%、93.10%、90.00%、77.27%和53.85%。结论女性MG患者经胸腺切除术治疗效果良好;加强围术期处理,合理使用抗胆碱酯酶药物和激素,可减少各种MG危象的发生。
Objective To summarize the surgical treatment and perioperative management of female myasthenia gravis (MG). Methods The clinical data of 186 female MG patients (including 41 cases of thoracic cardiovascular surgery in Affiliated Hospital of North Sichuan Medical College and 145 cases of thoracic cardiovascular surgery of Nanfang Hospital Affiliated to Southern Medical University) were retrospectively analyzed from January 1979 to December 2007. , Aged 5 to 64 years old, average age 43.9 years old. According to the Osserman clinical classification, there were 45 cases of pediatric MG and 141 cases of adult MG, including 25 cases of ocular muscle type, 63 cases of mild systemic type, 29 cases of moderate systemic type, 19 cases of acute fulminant type and 5 cases of advanced severe type. There were 166 cases with thymoma. According to Masaoka stage I 40 cases, stage II 69 cases, stage III 44 cases and stage IV 13 cases. One hundred and fifty-two patients underwent trans-sternotomy, and underwent thymectomy and mediastinal lymphadenectomy. Thirty-four cases of thymus without obvious hyperplasia were treated with simple thymectomy via cervical transverse incision. Results All patients died without surgery. Perioperative MG crisis occurred in 22 cases, the corresponding treatment cured. 165 cases were followed up for more than 12 months and 21 cases were lost to follow-up. There were 30 cases (18.18%) recovered, 28 cases (16.97%) were cured basically, 60 cases (36.36%) were markedly cured, 25 cases (15.15%) were improved, and 22 cases (13.33%) were ineffective. The effective rates of type Ⅰ, type Ⅱ a, type Ⅱ b, type Ⅲ and type Ⅳ were 100.00%, 93.10%, 90.00%, 77.27% and 53.85%, respectively. Conclusions Female patients with MG are treated by thymectomy well. Perioperative management and rational use of anticholinesterase drugs and hormones can reduce the occurrence of various MG crisis.