【摘要】 目的 探讨重症肌无力(MG)外科治疗的围手术期处理方法及疗效。方法 158例患者，男65例，女93例，年龄3～61岁，Osseman Ⅰ型93例，Ⅱa型38例，Ⅱb型17例，Ⅲ型10例。术前正确处理合并症，使用药物控制肌无力症状，术中完整切除胸腺并清扫前纵隔脂肪；术后联合使用抗胆碱酯酶药、激素及免疫抑制剂，应用呼吸机进行人工辅助呼吸，防治重症肌无力危象。结果 全组患者均无手术或住院死亡，Ⅰ型MG患者术后早期症状缓解26例，明显改善19例，改善27例；Ⅱ、Ⅲ型MG患者术后早期症状缓解33例，明显改善21例；总有效率为76.6%。结论 重症肌无力患者经充分的围手术期处理，可安全接受手术治疗，手术疗效好。

    【关键词】 重症肌无力；治疗；胸腺；围手术期处理

    Perioperative management of surgical therapy for myasthenia gravis

    LU Jian-jun,ZHEN Hai-wen,MA Jun,et al.Department of Thoracic Surgery,The First Affiliated Hospital,Sun Yat-Sen University,Guangzhou 510080,China

    【Abstract】 Objective To approach the method and curative effect of the perioperative management of surgical therapy for myasthenia gravis(MG).Methods 158 cases of MG including 65 male and 93 female,whose ages were from 3 years to 61 years,were operated.The Osserman grade in this group was define into grade Ⅰ including 93 cases,grade ⅡA including 38 cases,grade ⅡB including 17 cases and grade Ⅲ including 10 cases.The complications were treated exactly and the drugs were applied to control the symptom of MG before operation.The whole thoracic gland and the fat in anterior mediastinum were removed in operation.The breathing machine was used to provide ventilatory support after operation,in order to preventing and curing myasthenia gravis crisis.Results There were no patient dead in operation and in hospital.In patients with Osserman grade Ⅰ,in which 26 cases achieved remission,19 cases improved obviously,27 cases improved in earlier period after operation.In patients with Osserman grade Ⅱ and Ⅲ,in which 33 cases achieved remission,21 cases improved obviously.The total effective rate was 76.6%.Conclusion For the MG patients who reasonably received the perioperative management,the surgical therapy was safe.The curative effect of operation was satisfactory. ......