Sakamaki Yasushi, Yoon Hyung-Eun, Oda Naofumi
Department of General Thoracic Surgery, Rinku General Medical Center, Izumisano, Osaka, Japan.
Jpn J Thorac Cardiovasc Surg. 2006 May;54(5):207-11. doi: 10.1007/BF02670314.
A non-small-cell lung cancer without distant metastases was incidentally found in a 77-year-old man who had suffered from myasthenia gravis (MG) without thymoma. The patient's condition was stabilized by oral pyridostigmine bromide which he had taken during the past 6 years. He simultaneously underwent thymectomy and left lower lobectomy with regional lymph node dissection. Although postoperative myasthenic crisis occurred, mechanical ventilation and intravenous steroid pulse relieved the patient and the symptoms improved thereafter. Cases of operable lung cancer with non-thymomatous MG have rarely been reported and the appropriate therapeutic strategy for such cases remains to be debated. Their causal association remains to be identified, whereas some studies have implied that immune disorder due to the abnormal thymus might possibly enhance the oncogenesis of extrathymic malignancies. Myasthenic crisis should also be taken into account in postoperative management of MG patients who simultaneously undergo thymectomy and lobectomy for synchronous lung cancer.
一名77岁患有无胸腺瘤重症肌无力（MG）的男性患者偶然发现了一例无远处转移的非小细胞肺癌。患者的病情通过过去6年一直服用的口服溴吡斯的明得以稳定。他同时接受了胸腺切除术和左下叶切除术及区域淋巴结清扫术。尽管术后发生了重症肌无力危象，但机械通气和静脉注射类固醇冲击治疗使患者病情缓解，此后症状有所改善。可手术的非胸腺瘤性MG肺癌病例鲜有报道，此类病例的合适治疗策略仍有待探讨。它们之间的因果关系尚待确定，而一些研究暗示，胸腺异常导致的免疫紊乱可能会促进胸腺外恶性肿瘤的发生。对于同时接受胸腺切除术和同步肺癌肺叶切除术的MG患者，术后管理中也应考虑重症肌无力危象。
