| 摘要: |
| ［摘要］ 目的 探讨在特定条件下于重症肌无力危象（MC）期实施挽救性胸腺扩大切除术的可行性，并分析其可能缩短危象持续时间的理论机制。方法 回顾性分析2016年11月至2024年5月江西省人民医院胸外科收治并在MC期接受挽救性胸腺扩大切除术的12例患者的临床资料。其中男5例，女7例；改良Osserman分型均为Ⅲ型；血清抗乙酰胆碱受体抗体检测均为阳性。所有患者均接受基线药物治疗（溴吡斯的明、泼尼松）及辅助治疗（血浆置换、静脉注射丙种球蛋白）。术前呼吸支持方式包括无创呼吸机通气1例、气管插管机械通气11例，其中3例行气管切开。结果 12例患者均于MC期顺利完成胸腺扩大切除术。术后并发症包括1例喉返神经损伤并发严重肺部感染，最终因呼吸衰竭死亡；1例因气管导管堵塞致心脏骤停，虽经心肺复苏恢复循环，但出现缺氧性脑病死亡。其余10例患者均安全出院，随访6个月肌无力症状缓解。结论 在具备胸外科专科重症监护室、多学科协作团队及丰富MC处理经验的医疗条件下，MC期胸腺扩大切除术可作为挽救性治疗方案，具有一定可行性，但仍存在手术风险。 |
| 关键词: 特定条件 重症肌无力 重症肌无力危象 胸腺扩大切除术 |
| DOI：10.3969/j.issn.1674-3806.2025.10.03 |
| 分类号: |
| 基金项目:江西省卫生厅科技计划课题（编号：20131010，20091017） |
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| Exploration on salvage extended thymectomy for myasthenic crisis under specific conditions |
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LIU Yangchun, CHEN Liru, YIN Sui, ZHONG Yingmei
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Department of Thoracic Surgery, Jiangxi Provincial People′s Hospital(the First Affiliated Hospital of Nanchang Medical College), Nanchang 330006, China
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| Abstract: |
| ［Abstract］ Objective To explore the feasibility of performing salvage extended thymectomy for myasthenic crisis(MC) under specific conditions, and to analyze the potential theoretical mechanisms of the operation for shortening the duration of the crisis. Methods A retrospective analysis was conducted on the clinical data of 12 patients who were admitted to Department of Thoracic Surgery, Jiangxi Provincial People′s Hospital from November 2016 to May 2024 and underwent salvage extended thymectomy for MC. Among the 12 patients, there were 5 males and 7 females. According to the modified Osserman classification, all of the patients′ diseases were classified as type Ⅲ, and their serum anti-acetylcholine receptor antibodies were positive. All of the patients received baseline drug therapy(pyridostigmine and prednisone) and adjuvant therapy(plasma exchange and intravenous gamma-globulin). Before the operation, the patients received respiratory support and the respiratory support modes included non-invasive ventilation in 1 patient and tracheal intubation with mechanical ventilation in 11 patients. Among the 11 patients receiving tracheal intubation with mechanical ventilation, 3 patients underwent tracheotomy. Results All of the 12 patients were successfully completed the extended thymectomy for MC. The postoperative complications included recurrent laryngeal nerve injury complicated with severe pulmonary infection in 1 patient and the patient eventually died of respiratory failure, and tracheal tube obstruction leading to cardiac arrest in 1 patient. Although the cardiac arrest patient got restoration of blood circulation after cardiopulmonary resuscitation, the patient still died of hypoxic encephalopathy. The other 10 patients were discharged from the hospital smoothly and achieved relief of myasthenia gravis symptoms during a 6-month follow-up. Conclusion Under the medical conditions such as a thoracic surgery specialty with an intensive care unit, a multidisciplinary collaborative team with rich experience in handling MC, extended thymectomy can be used as a salvage therapeutic regimen for MC and has certain feasibility, but there are still surgical risks. |
| Key words: Specific conditions Myasthenia gravis Myasthenic crisis(MC) Extended thymectomy |
