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[重症肌无力和/或胸腺瘤的胸腺切除术]

[Thymectomy in myasthenia and/or thymoma].

作者信息

Rückert J C, Ismail M, Badakhshi H, Meisel A, Swierzy M

机构信息

Bereich Thoraxchirurgie der Charité, Universitätsmedizin Berlin.

Klinik für Radioonkologie und Strahlentherapie CVK-Hyperthermie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin.

出版信息

Zentralbl Chir. 2014 Feb;139(1):121-32; quiz 133-4. doi: 10.1055/s-0033-1360304. Epub 2014 Feb 28.

Abstract

Thymectomy, the surgical removal of the thymic gland, is essential in cases of thymoma. The majority of cases of a myasthenia gravis (MG) represent a relative indication for thymectomy which requires cooperation with specialized neurologists. Patients with MG may present with a tumor of the thymic gland. In case of suspicious thymoma, the resectability of the tumor has to be evaluated in the preoperative diagnostic. The clinical condition of patients with MG has to be stabilized preoperatively. The aim of thymectomy is the radical removal of thymoma and/or maximal improvement of MG symptoms. This requires the complete extirpation of the thymic gland including all ectopic thymic tissue in the anterior mediastinum. There is a variety of surgical techniques for performing a complete thymectomy. In addition to the conventional techniques with sternotomy, the significance of minimally-invasive approaches is increasing rapidly. Despite the ongoing scarcity of data of higher evidence concerning the procedure of thymectomy an increasing number of equivalent results with minimally-invasive operation techniques for MG and for thymoma are available. The successful surgical performance of a thymectomy is part of an interdisciplinary cooperation in the perioperative treatment of MG as well as the postoperative long-term care for patients with MG and/or thymoma.

摘要

胸腺切除术,即手术切除胸腺,对于胸腺瘤病例至关重要。大多数重症肌无力(MG)病例是胸腺切除术的相对适应证,这需要与专业神经科医生合作。MG患者可能伴有胸腺肿瘤。对于可疑胸腺瘤,必须在术前诊断中评估肿瘤的可切除性。MG患者的临床状况必须在术前稳定下来。胸腺切除术的目的是彻底切除胸腺瘤和/或最大程度改善MG症状。这需要完全切除胸腺,包括前纵隔内所有异位胸腺组织。有多种手术技术可用于完成胸腺切除术。除了传统的胸骨切开术技术外,微创方法的重要性正在迅速增加。尽管关于胸腺切除术的高级别证据数据仍然稀缺,但越来越多的MG和胸腺瘤微创操作技术取得了等效结果。胸腺切除术的成功实施是MG围手术期治疗以及MG和/或胸腺瘤患者术后长期护理中跨学科合作的一部分。

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