Urschel J D, Grewal R P
Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY 14263-0001, USA.
Postgrad Med J. 1998 Mar;74(869):139-44. doi: 10.1136/pgmj.74.869.139.
The pathophysiological role of the thymus in myasthenia gravis, and the mechanism of therapeutic effect of thymectomy, are incompletely understood. Nevertheless, thymectomy is a valuable treatment modality in selected patients with generalised myasthenia gravis. There are several types of thymectomy operation, but no one operative approach is clearly superior to the others. Total removal of the thymus gland is essential. Additional excision of associated mediastinal and cervical tissue, that may harbor ectopic thymic rests, is a controversial surgical issue. Surgeons that advocate thymectomy through small, cosmetically favourable, incisions usually believe that simple removal of the thymus gland is an adequate operation. Surgeons that emphasise the importance of removing extrathymic tissue, in addition to the thymus gland, usually favour greater operative exposure through a median sternotomy. To minimise operative morbidity, surgery for myasthenia gravis requires a multidisciplinary (neurology, surgery, anaesthesia) approach to peri-operative care.
胸腺在重症肌无力中的病理生理作用以及胸腺切除术的治疗作用机制尚未完全明确。然而，对于部分全身性重症肌无力患者，胸腺切除术是一种有效的治疗方式。胸腺切除术有多种术式，但尚无一种术式明显优于其他术式。胸腺的完整切除至关重要。是否额外切除可能含有异位胸腺残余组织的相关纵隔及颈部组织是一个有争议的外科问题。主张通过美观性较好的小切口进行胸腺切除术的外科医生通常认为单纯切除胸腺即已足够。而强调除胸腺外还需切除胸腺外组织的外科医生通常更倾向于通过正中胸骨切开术获得更大的手术视野。为将手术并发症降至最低，重症肌无力的手术治疗需要多学科（神经科、外科、麻醉科）团队参与围手术期护理。
