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胸腺切除术已成为全身型重症肌无力的标准疗法.近来研究表明,扩大胸腺切除术,即切除前纵隔全部胸腺及淋巴组织,较单纯大部胸腺切除缓解率高.据此,作者对开始未作扩大胸腺切除术的6例慢性难治性重症肌无力病人进行了再次手术.本组包括男性3例,女性3例,平均年龄36岁(22～49岁)病程12～20年,都在诊断重症肌无力二年内做过第一次胸腺切除术.再次手术距第一次手术时间5～18年.患者均丧失活动能力,用大剂量强的松、细胞毒药及吡啶斯的明维持,其中5例还长期接受血浆置换疗法.5例血清乙酰胆碱受体抗体滴度升高.再次手术全部采用胸骨正中切开,探查范围上至甲状腺下至膈肌,注意显露和保护好大血管
Thymectomy has become the standard treatment for systemic myasthenia gravis recently studies have shown that the expansion of the thymectomy, that is, the removal of the anterior mediastinal thymus and lymphoid tissue, compared with the simple majority of thymectomy remission rate accordingly, the author of the beginning Six patients with chronic refractory myasthenia gravis undergoing thymus resection were undergone reoperation.The group consisted of 3 males and 3 females with a mean age of 36 years (22-49 years) with a duration of 12 to 20 years Diagnosis of myasthenia gravis The first thymectomy was performed within two years.Re-operation from the first operation time of 5 to 18 years.All patients lost activity, with high-dose prednisone, cytotoxic and pyridostigmine maintenance, Of which 5 patients also received long-term plasma exchange therapy .5 cases of serum acetylcholine receptor antibody titers .Surgical re-operation of all sternal midline incision, exploration range from the thyroid to the diaphragm, pay attention to reveal and protect the large blood vessels