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内镜下胸腺切除术:神经科医生的观点。

Endoscopic thymectomy: a neurologist's perspective.

作者信息

Ricciardi Roberta, Melfi Franca, Maestri Michelangelo, De Rosa Anna, Petsa Afroditi, Lucchi Marco, Mussi Alfredo

机构信息

1 Department of Clinical and Experimental Medicine, Neurology Unit, 2 Division of Thoracic Surgery, Robotic Multidisciplinary Centre for Surgery, Cardiothoracic and Vascular Surgery Department, University of Pisa, Italy ; 3 Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK.

出版信息

Ann Cardiothorac Surg. 2016 Jan;5(1):38-44. doi: 10.3978/j.issn.2225-319X.2015.12.02.

Abstract

Myasthenia gravis (MG) is an autoimmune neuromuscular disease characterized by the presence of antibodies interacting at the neuromuscular junction (NMJ), resulting in loss of strength and severe exhaustibility of striated muscles. The abnormal production of these antibodies is triggered mainly in the thymus, and hence thymectomy in MG is considered a universally recommended treatment in order to improve the symptomatologic condition of this pathology. Currently, minimally invasive thymectomy using the Da Vinci robot system is certainly one of the most innovative techniques, performed in Pisa since 2001. This approach provides a valuable alternative to the traditional thymectomy through median sternotomy. The contribution of a neurologist is fundamental for preoperative patient selection and for the peri-operative clinical assistance in both approaches. We believe that in the robotic approach, the multidisciplinary collaboration between the neurologist, thoracic surgeon and anesthetist is important in reducing perioperative complications and ensuring a higher rate of complete remission or stable clinical improvement of MG.

摘要

重症肌无力(MG)是一种自身免疫性神经肌肉疾病,其特征是存在在神经肌肉接头(NMJ)处相互作用的抗体,导致横纹肌力量丧失和严重易疲劳性。这些抗体的异常产生主要在胸腺中触发,因此,重症肌无力患者的胸腺切除术被认为是普遍推荐的治疗方法,以改善这种疾病的症状状况。目前,自2001年以来在比萨进行的使用达芬奇机器人系统的微创胸腺切除术无疑是最具创新性的技术之一。这种方法为传统的正中胸骨切开胸腺切除术提供了一种有价值的替代方案。神经科医生的贡献对于术前患者选择以及两种手术方式的围手术期临床辅助至关重要。我们认为,在机器人手术方式中,神经科医生、胸外科医生和麻醉师之间的多学科协作对于减少围手术期并发症以及确保更高的重症肌无力完全缓解率或稳定临床改善率很重要。

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