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find Keyword "胸腺切除术" 19 results
  • Progress in Thymectomy for the Treatment of Non-thymomatous Myasthenia Gravis

    Thymectomy is a major surgical procedure for patients with non-thymomatous myasthenia gravis,and can enhance their symptomatic remission rate and cure rate. There is still much controversy about appropriate surgical approach and extent of resection of thymectomy. The majority of thoracic surgeons believe that the completeness of thymectomy is closely associated with clinical symptom improvement,and perform complete resection of encapsulated thymus and surroun-ding fat tissues via mid-sternotomy. But minimally invasive thymectomies are often more acceptable by patients. On the contrary,in view of common existence of ectopic thymus tissue,some thoracic surgeons advocate a combination of cervical incision and sternotomy in order to further completely remove all thymus tissue.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • Robot-assisted Extended Thymectomy for TypeⅠMyasthenia Gravis Using Da Vinci S System

    Objective To investigate application values and techniques of robot-assisted extended thymectomy for the treatment of typeⅠmyasthenia gravis (MG) using Da Vinci S system. Methods We retrospectively analyzed clinical data of 3 patients with MG who underwent robot-assisted extended thymectomy in General Hospital of Shenyang Military Command from March 2012 to September 2012. All the patients were ocular MG (typeⅠ) including 2 men (33 years and 66 years old respectively) and 1 woman (21 years old). Surgical outcomes were analyzed. Results All the 3 patients successfully received robot-assisted extended thymectomy without accessorial incisions. None of the patients required converting to open sternotomy or postoperative reexploration for bleeding. Intraoperative blood loss was 5-10 ml.Overall operation time was95-138 minutes, and thymoma dissection time was 26-80 minutes. No myasthenic crisis or other major postoperative complic-ation occurred. Postoperative chest drainage duration was 3-9 days and postoperative hospital stay was 10-15 days. Two patientswere followed up for 6-12 months after discharge without MG recurrence. Conclusion Robot-assisted extended thymectomy is safe and feasible for the treatment of typeⅠMG with satisfactory results.

    Release date:2016-08-30 05:47 Export PDF Favorites Scan
  • 经左胸电视胸腔镜下全胸腺切除40例临床分析

    目的探讨经左胸电视胸腔镜下全胸腺切除术的可行性和有效性。方法回顾性分析苏州大学附属第一医院 2008年 5月至 2011年 5月期间收治 40例胸腺疾病和重症肌无力手术患者的临床资料,男 13例,女 27例;平均年龄 44(12~ 72)岁。均于胸腔镜下经左胸行全胸腺切除术,其中重症肌无力患者行全胸腺及前纵隔脂肪和心包脂肪垫切除术。结果术后病理诊断为胸腺增生 18例、胸腺瘤 15例、胸腺囊肿 3例,4例胸腺组织未见明显异常。无围手术期并发症及死亡发生。根据美国重症肌无力协会( MGFA)疗效判断标准, 21例重症肌无力患者术后完全缓解率 38.09%(8/21),药物缓解率 42.86%(9/21),无明显缓解率 19.05%(4/21);术后随访 1~ 24个月,所有患者术后行胸部 CT、磁共振成像( MRI) 等检查,未见肿瘤复发。结论经左胸电视胸腔镜下全胸腺切除术安全可行,具有创伤小、并发症少、切除彻底等优点,可作为治疗部分胸腺疾病和重症肌无力的手术方法之一。

    Release date:2016-08-30 05:49 Export PDF Favorites Scan
  • 女性重症肌无力患者的外科治疗与围术期处理

    摘要: 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。

    Release date:2016-08-30 06:03 Export PDF Favorites Scan
  • 96例重症肌无力患者的外科治疗

    目的 总结重症肌无力(MG)患者的外科治疗和围术期处理经验,以提高手术疗效。 方法 2002年1月至2007年6月,对96例MG患者行胸腺切除加前纵隔脂肪组织清扫术,根据临床相对记分、服药量改变及生活能力于术后3个月评估临床疗效。 结果 无围术期死亡。术后发生MG危象8例(8.3% ),其中术前未服用糖皮质激素6例(18.75%),服用糖皮质激素2例(3.13%),经相应的治疗治愈。术后发生其他并发症9例(9.4%),其中肺部感染7例,切口感染2例,均经相应的治疗治愈。随访96例,随访时间3~18个月,其中32例临床痊愈,30例基本痊愈,15例显效,12例好转,7例无效。 结论 MG患者经内科治疗效果不佳或无效时,均应考虑手术治疗,无论是否有胸腺增生,特别是对合并有胸腺瘤者,应限期手术。若决定行手术治疗,术前除继续服用抗胆碱酯酶药物外,口服糖皮质激素15d左右可增加手术安全性,提高手术疗效。

    Release date:2016-08-30 06:04 Export PDF Favorites Scan
  • 胸腺切除术治疗重症肌无力102例分析

    目的总结胸腺切除术治疗重症肌无力(myasthenia gravis,MG)的经验。方法回顾1990年1月~2004年12月对102例MG患者行胸腺切除术的临床资料,从性别、年龄、病程、Osserman分型、纵隔脂肪组织清扫程度和病理结果等6个方面统计分析影响疗效的因素。结果102例患者术后发生并发症22例(21.6%),其中危象14例(13.7%),死亡2例(2.0%),1例死于肺部感染,1例放弃治疗。术后平均随访5年,治愈率为29.4%(30/102),总有效率为82.4%(84/102)。Osserman分型、纵隔脂肪组织清扫程度和病理结果对有效率有影响(P〈0.05)。结论扩大胸腺切除术是治疗MG安全、有效的方法,而围手术期处理是综合治疗MG的重要组成部分;Osserman分型、纵隔脂肪组织清扫程度和病理结果是影响手术疗效的重要因素。

    Release date:2016-08-30 06:23 Export PDF Favorites Scan
  • 电视胸腔镜下胸腺切除术治疗重症肌无力

    目的探讨电视胸腔镜手术(VATS)下行胸腺切除治疗重症肌无力的可行性和治疗效果。方法19例重症肌无力患者,按照Osserman临床分型标准,Ⅰ型10例,Ⅱa型5例,Ⅱb型3例,Ⅲ型1例,均在VATS下行胸腺扩大切除术。结果19例患者均顺利完成手术,无手术死亡,平均手术时间120min,术中出血量均小于100ml,术后发生重症肌无力危象3例,经及时治疗治愈。术后对所有患者均进行了随访,随访时间〉6个月,重症肌无力病情完全缓解9例,好转6例,无变化4例,总有效率79%(15/19)。结论在VATS下行胸腺扩大切除术治疗重症肌无力是可行的,且创伤小、疼痛轻,以期望减少术后并发症。

    Release date:2016-08-30 06:26 Export PDF Favorites Scan
  • 小儿重症肌无力的外科治疗

    目的 探讨小儿重症肌无力(MG)的手术适应证,围手术期处理及影响疗效的有关因素.方法 按Osserman临床分型分为Ⅰ型(单纯眼肌型)11例,ⅡA型(轻度全身型)6例,ⅡB型(中度全身型)2例.胸腺病理检查:增生12例,正常组织学表现7例,无合并胸腺瘤者.12例胸腺标本进行了免疫组织化学观察.结果 全组无手术死亡.术后发生肌无力危象1例,总有效率89.5%.全身型术后缓解率75%,较单纯眼肌型36.3%高.常规病理分型与疗效无关,根据免疫组织化学观察,12例胸腺分为上皮细胞密集型6例和上皮细胞松散型6例,两者术后疗效相差显著.结论 小儿全身型MG应行手术治疗,而对单纯眼肌型MG的手术适应证应从严掌握,对学龄前儿童尽可能采用药物治疗.使用人工呼吸器是治疗术后肌无力危象的有效措施.胸腺免疫组织化学分型能较好地评估手术后的疗效.

    Release date:2016-08-30 06:35 Export PDF Favorites Scan
  • Clinical study on the ocular myasthenia gravis

    Objective To observe the clinical manifestations and treatment of ocular myasthenia gravis. Methods The clinical manifestations, results of laboratory examination and thymic CT, and therapeutic data of 84 patients with ocular myasthenia gravis, hospitalized from July, 1998 to July, 2005, were retrospective ly analyzed. Results These patients were 2.5 to 70 years old. All of the patients had ptosis, includine 35.77% with diplopia 25% with strabismus; 1 with obnormal sphincter muscle and 1 with blurry vision.The positive rate of examination of AchR antibody was 27.6%, and abnormal rate of examination of thymic CT was 64.3%. The cure rate was 48.1% in oral administration with tabellae in whomdostigmini group, 66.7% in methylprednisolonum hormone therapy group, and 51.9%in thymectomy group. Conclusions Ocular myasthenia gravis is mostly involved levator palpebrae superiors and sometimes also involved other ocular muscles. Anticholinesterase medication, methylprednisolonum hormone therapy or thymec tomy are effective. (Chin J Ocul Fundus Dis, 2006,22:379-381)

    Release date:2016-09-02 05:51 Export PDF Favorites Scan
  • The Application of Noninvasive Ventilation in Patients with Myasthenic Crisis after Thymectomy

    ObjectiveTo investigate the effect of noninvasive ventilation (NIV) in patients with myasthenic crisis after thymectomy. Methods31 myasthenic crisis patients after thymectomy who initially used NIV,admitted in the First Affiliated Hospital of Guangzhou Medical University between January 2011 and June 2013,were analyzed retrospectively.They were assigned to two groups according to the successful application of NIV or not,with 13 patients in the NIV success group and 18 patients in the NIV failure group.The related factors including gender,age,APACHEⅡ score when admitted to ICU,the results of blood gas analysis before NIV,thymoma or not,the history of myasthenic crisis,the history of chronic lung disease,and minute ventilation accounted for the largest percentage of predicted value (MVV%pred)were analyzed. ResultsThere were no significant differences in age,gender,or APACHEⅡ score between two groups (P>0.05).The PaCO2 in the NIV success group was lower than that in the NIV failure group.The preoperative MVV%pred in the NIV success group was higher than that in the NIV failure group.There were no significant differences between two groups in pH,PO2,thymoma or not,the history of myasthenic crisis,or the history of chronic lung disease (P>0.05).If using the 45 mm Hg as the cut-off value of PaCO2 and 60% as the cut-off value of MVV%pred,the incidence of PaCO2<45 mm Hg and the incidence of MVV%pred>60% were higher in the NIV success group than those in the NIV failure group (84.6% vs.33.3%, P<0.05;100% vs. 55.6%,P<0.05).Logistic regression analysis revealed that PaCO2<45 mm Hg was an independent influence factor for successful application of NIV in patients with myasthenic crisis after thymectomy. ConclusionPaCO2<45 mm Hg can be a predictor of successful application of NIV in patients with myasthenic crisis after thymectomy.For the patients underwent NIV whose PaCO2<45 mm Hg or MVV%pred<60%,the clinician should predict the possibility of failure and prepared for intubation.

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