Exploration on salvage extended thymectomy for myasthenic crisis under specific conditions
LIU Yangchun
CHEN Liru
YIN Sui
ZHONG Yingmei
Abstract：Objective To explore the feasibility of performing salvage extended thymectomy for myasthenic crisis(MC)under specific conditions,and to analyze the potential theoretical mechanisms of the operation for shortening the duration of the crisis.Methods A retrospective analysis was conducted on the clinical data of 12 patients who were admitted to Department of Thoracic Surgery,Jiangxi Provincial People's Hospital from November 2016 to May 2024 and underwent salvage extended thymectomy for MC.Among the 12 patients,there were 5 males and 7 females.According to the modified Osserman classification,all of the patients'diseases were classified as typeⅢ,and their serum anti-acetylcholine receptor antibodies were positive.All of the patients received baseline drug therapy(pyridostigmine and prednisone)and adjuvant therapy(plasma exchange and intravenous gamma-globulin).Before the operation,the patients received respiratory support and the respiratory support modes included non-invasive ventilation in 1 patient and tracheal intubation with mechanical ventilation in 11 patients.Among the 11 patients receiving tracheal intubation with mechanical ventilation,3 patients underwent tracheotomy.Results All of the 12 patients were successfully completed the extended thymectomy for MC.The postoperative complications included recurrent laryngeal nerve injury complicated with severe pulmonary infection in 1 patient and the patient eventually died of respiratory failure,and tracheal tube obstruction leading to cardiac arrest in 1 patient.Although the cardiac arrest patient got restoration of blood circulation after cardiopulmonary resuscitation,the patient still died of hypoxic encephalopathy.The other 10 patients were discharged from the hospital smoothly and achieved relief of myasthenia gravis symptoms during a 6-month follow-up.Conclusion Under the medical conditions such as a thoracic surgery specialty with an intensive care unit,a multidisciplinary collaborative team with rich experience in handling MC,extended thymectomy can be used as a salvage therapeutic regimen for MC and has certain feasibility,but there are still surgical risks.
Keywords：Specific conditionsMyasthenia gravisMyasthenic crisis(MC)Extended thymectomy
Publication Date：2025-10-30
Online Publishing Date：2025-11-13(First online date of this platform, not the publication date of the document)
Pages：6( 1086-1091 )