Asai Katsuyuki, Suzuki Kazuya, Washiyama Naoki, Terada Hitoshi, Yamashita Katsushi, Kazui Teruhisa
First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Jpn J Thorac Cardiovasc Surg. 2004 Feb;52(2):65-7. doi: 10.1007/s11748-004-0085-0.
A 57-year-old man with ocular myasthenia gravis was admitted to our hospital because of acute respiratory insufficiency associated with myasthenic crisis. He had a history of unstable angina indicated percutaneous coronary artery angioplasty. He was diagnosed with generalized nonthymomatous myasthenia gravis and a triple vessel coronary artery disease. We conducted a simultaneous surgical intervention, including extended thymectomy and coronary artery bypass grafting, using a standard cardiopulmonary bypass via median sternotomy. The patient had already been immunocompromised at surgery for having diabetes, and postoperative long-term steroid therapy. In this rare and special condition, a meticulous overall therapeutic strategy was needed in order to avoid myasthenic crisis and prepare for the worst case scenario of mediastinitis.
一名57岁的重症肌无力患者因重症肌无力危象伴急性呼吸功能不全入住我院。他有不稳定型心绞痛病史，曾行经皮冠状动脉腔内血管成形术。他被诊断为全身性非胸腺瘤性重症肌无力和三支血管冠状动脉疾病。我们通过正中胸骨切开术，采用标准体外循环，同时进行了手术干预，包括扩大胸腺切除术和冠状动脉搭桥术。该患者因患有糖尿病及术后长期接受类固醇治疗，手术时已处于免疫功能低下状态。在这种罕见且特殊的情况下，需要精心制定全面的治疗策略，以避免重症肌无力危象，并为纵隔炎的最坏情况做好准备。
