RESUMO
Surgical treatment of myasthenia gravis has at the 3 (rd) Department of Surgery, 1 (st) Medicine Faculty of Charles University in Prague a multiyear tradition which has originated in the 60's of the 20 (th) century. Since that time we carried out over 1 000 operations on the thymus, especially thymectomy for myasthenia gravis (MG) and with lesser frequency for thymomas. Thymectomy combined with exenteration of fatty tissue from the front mediastinum belongs to basic MG surgery. According to our experience an optimal approach to the thymus is given by partial sternotomy. A jugular approach is not regarded as enough radical. Videothoracoscopic approach and operation are possible but take more time, however they are the method of choice at some workplaces. The combined conservative and surgical treatment brings in 80 % of the cases an obvious improvement or deletion of the symptoms of the disease.
Assuntos
Miastenia Gravis/cirurgia , Timectomia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Idoso , Criança , Contraindicações , Feminino , Humanos , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/classificação , Miastenia Gravis/diagnóstico , Miastenia Gravis/diagnóstico por imagem , Fatores de Risco , Esterno/cirurgia , Cirurgia Torácica Vídeoassistida , Timoma/classificação , Timoma/diagnóstico , Neoplasias do Timo/classificação , Neoplasias do Timo/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Surgical treatment of myasthenia gravis at the 3rd Department of Surgery, 1st Faculty of Medicine, Charles University in Prague, has long tradition. It originated in sixties of the 20th century. Over 1000 operations of a thymus has been carried out since that time, especially thymectomy for myasthenia gravis (MG) and for less frequent thymomas. The complete removal of thymus--thymectomy accompanied with exenteration of the fat in frontal mediastinum belongs to the principal MG surgery. According to our experience, the optimal approach to the thymus is a partial sternotomy. The jugular approach is not regarded as sufficiently radical. Videothoracoscopic approach and operation are possible but they are longer. They represent a method of choice at some workplaces. The combined MG treatment (conservative medicamentous and surgery treatment) brings in 80% a visible improvement and a deletion of symptoms of the disease.
Assuntos
Miastenia Gravis/cirurgia , Timectomia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Humanos , Complicações Pós-Operatórias , Timectomia/efeitos adversos , Timectomia/métodosRESUMO
Surgical treatment of thymomas is indicated for Masaoka stage 1 to 3. We are not in favor of mini-invasive techniques. We consider a gold standard to be sternotomy followed by a tumor removal and extended thymectomy. We are convinced it is necessary to perform sternotomy, tumor removal and extended thymectomy after a thymoma resection through thoracotomy to prevent a late onset of myasthenia gravis. In stages 2 to 3 actinotherapy along with chemotherapy should follow surgery to increase the patient's chances for a prolonged survival (Tab. 10).
Assuntos
Timoma/cirurgia , Neoplasias do Timo/cirurgia , Humanos , Taxa de Sobrevida , Timoma/mortalidade , Neoplasias do Timo/mortalidadeRESUMO
A group of patients with myasthenia gravis operated at the Third Surgical Clinic, Faculty Hospital had in 20.5% a thymoma. Before operation CT did not detect the thymoma in 13.8% of the thymomas detected during operation and verified by histological examination. This fact must be taken into account when indicating conservative treatment in a myasthenic patient.
