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重症肌无力的胸腺手术前景与展望

Thymus Surgery Prospectives and Perspectives in Myasthenia Gravis.

作者信息

Salahoru Paul, Grigorescu Cristina, Hinganu Marius Valeriu, Lunguleac Tiberiu, Halip Alina Ioana, Hinganu Delia

机构信息

Department of Surgery I, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.

Department of Morpho-Functional Sciences I, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.

出版信息

J Pers Med. 2024 Feb 23;14(3):241. doi: 10.3390/jpm14030241.

Abstract

The thymus is a lymphoid organ involved in the differentiation of T cells, and has a central role in the physiopathogenesis of Myasthenia Gravis (MG). This connection is proved by a series of changes in the level of neuromuscular junctions, which leads to a decrease in the amplitude of the action potential in the post-synaptic membrane. Because of this, the presence of anti-cholinergic receptor antibodies (AChR), characteristic of MG, is found, which causes the progressive regression of the effect of acetylcholine at the level of neuromuscular junctions, with the appearance of muscle weakness. The thymectomy is a surgical variant of drug therapy administered to patients with MG. In the case of patients with nonthymomatous MG, thymectomy has become a therapeutic standard, despite the fact that there is no solid scientific evidence to explain its positive effect. Videothoracoscopic surgery or robotic surgery led to a decrease in the length of hospital stay for these patients. This paper aims to synthesize the information presented in the literature in order to create a background for the perspectives of thymectomy.

摘要

胸腺是一个参与T细胞分化的淋巴器官,在重症肌无力(MG)的生理发病机制中起核心作用。神经肌肉接头水平的一系列变化证实了这种联系,这些变化导致突触后膜动作电位幅度降低。因此,发现了重症肌无力特有的抗胆碱能受体抗体(AChR)的存在,这导致乙酰胆碱在神经肌肉接头水平的作用逐渐消退,出现肌肉无力。胸腺切除术是用于重症肌无力患者的药物治疗的一种手术方式。对于非胸腺瘤性重症肌无力患者,尽管没有确凿的科学证据解释其积极效果,但胸腺切除术已成为一种治疗标准。电视胸腔镜手术或机器人手术缩短了这些患者的住院时间。本文旨在综合文献中呈现的信息,为胸腺切除术的前景创造一个背景。

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Outcomes after thymectomy in non-thymomatous myasthenia gravis.非胸腺瘤性重症肌无力患者胸腺切除术后的结局
J Thorac Dis. 2023 Jun 30;15(6):3048-3053. doi: 10.21037/jtd-22-1589. Epub 2023 May 8.
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Myasthenia gravis. Update on diagnosis and therapy.重症肌无力。诊断和治疗的最新进展。
Med Clin (Barc). 2023 Aug 11;161(3):119-127. doi: 10.1016/j.medcli.2023.04.006. Epub 2023 May 27.
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Robotic thymectomy: a review of techniques and results.机器人辅助胸腺切除术:技术与结果综述
Kardiochir Torakochirurgia Pol. 2023 Mar;20(1):36-44. doi: 10.5114/kitp.2023.126097. Epub 2023 Apr 3.

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