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Objective:To discuss the perioperative symptom change rule of patients with myasthenia gravis(MG), and to provide a theoretical basis for preventing and reducing the surgical risk of patients with MG.Methods:The clinical data of 104 patients who underwent thymectomy in the Department of Thoracic Surgery of the Second Affiliated Hospital of Zhengzhou University from 2015 to 2019 were retrospectively analyzed. According to the degree of the impact of MG symptoms on the body's physiology and life, the "MG dynamic classification standard" was formulated, which was divided into type 0-type Ⅳ according to the severity of MG symptoms. The symptoms of each patient of "admission", "preoperative" and "postoperative" are classified according to the "dynamic classification criteria", and the number of "admission", "preoperative" and "postoperative" were counted respectively. Based on the statistical analysis of each patient's type changes, the perioperative symptom changes of myasthenia gravis patients were summarized.Results:1. "Admission" classification: 12 cases of type 0, 42 cases of type Ⅰ, 32 cases of type Ⅱ, 12 cases of type Ⅲ, 5 cases of type Ⅳa, and 1 case of type Ⅳb. 2. "Preoperative" classification: 44 cases of type 0, 34 cases of type Ⅰ, 14 cases of type Ⅱ, 12 cases of type Ⅲ; 68 cases of preoperative symptom reduction (65.4%, 68/104), 36 cases of preoperative symptom stable (34.6%, 36/104). Asymptomatic aggravation. 3. "Postoperative" classification: 49 cases of type 0, 21 cases of type Ⅰ, 11 cases of type Ⅱ, 10 cases of type Ⅲ, 9 cases of type Ⅳa, 4 cases of type Ⅳb; 33 cases (31.7%, 33/104) had postoperative symptoms aggravated. Among the patients with worsening symptoms after surgery, 5 cases (15.2%, 5/33) worsened on the first day after surgery, 9 cases (27.2%, 9/33) worsened on the second day after surgery, and 13 cases (39.4%, 13/33) worsened on the third day after surgery. There were 4 cases (12.1%, 4/33) worsened on the 4th day, and 2 cases (6.1%, 2/33) worsened on the 5th day after surgery.Conclusion:MG patients had different conditions at admission. After individualized perioperative treatment, more than half of the patients' symptoms alleviated to varying degrees. After the operation, the symptoms of MG will be temporarily aggravated due to the effects of surgery and anesthesia, and the aggravation period is mostly on 1-3 days. Reasonable selection of low-risk MG patients for surgery, avoiding the superposition of other influencing factors in the postoperative exacerbation period, is expected to reduce the occurrence of postoperative crises in MG patients.
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It is difficult to define whether the thymoma is benign or malignant because of its morphological heterogeneity. The structure of the mediastinum is complex,and the tumor′s invasion of different structures will have different effects on the prognosis of the patients. These characteristics make it difficult for clinicians to assess their prognosis. The histology classification and clinical staging were used to determine the prognosis. But the existing staging types are complex and are not well matched with the prognosis.
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Objective To discover the effect of pleurodesis with single utility port vido-assested thoracic surgery on patients with malignant pleural effusion.Methods Clinical pleurodesis data of 24 patients with malignant pleural effusion were analyzed retrospectively.Results After treatment,all the patients were no perioperative deaths.The operation time was 32 to 83 min,and average time was 34.5 min.The time of extubation was 4 to 15 d,and average time was 5.6 d.Among 24 patients with pleurodesis underwent regularly postoperative CT scan and follow-up,one case died of a brain metastasis after five months later,the other patients were survive more than six months.Conclusions Pleurodesis with single utility port video-assisted thoracoscopic surgery in the treatment of malignant pleural effusion is a minimally invasive,effective and practical method.
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Objective: To present the clinical experience in treating thymomas and thymomas with myasthenia gravis (MG). Methods: Between 1975 to 1997, 258 patients with thymoma were surgically treated. 168 cases of thymus tumor (TT, Group I) were compared to 90 cases of thymus tumor with myasthenia gravis (TTMG, Group II). Results: In group I, the average age was 38.4 years, the youngest was 4 years old. In 93.4%, the diameter of tumors was 5cm. 61.2% were in stages III and IV of clinical pathology. In group II, the average age was 46.2 with the youngest of 20 years old, the diameter of tumor under 3cm and 5cm was 34.6% and 65.6%. 55.2% was in stage I of clinical pathology. Conclusion: Many cases of thymoma in early stage received early treatment. The diagnostic standard of thymoma in early stage is: (1) the diameter of tumor is below 3cm. (2) In stage I of clinical pathology. The clinical characteristics of TTMG are : short history, the rapid progress, serious MG symptoms, and the high incidence of thymus-crisis.
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Objective To summarize the experience of the prevention and treatment on bronchopleural fistula (BF) complicated after pneumonectomy.Methods Clinical analysis of 22 cases of BF was retrospectively performed.Results The total incidence was 1.12%.The incidence of BF after total pneumonectomy was 1.7%,which was higher than that after pulmonary lobectomy (1.0%).The average time for the BF to occur was 13.8 days postoperatively.4 cases received operation again befroe healing occurred and 5 cases ended up in death (22.7%).Conclusion The key factors in preventing BF mainly lie in the suture techniques of bronchial residual stumps as well as the relevant factors influencing the healing.