Timektomija kod bolesnika oboljelih od miastenije gravis

Abstract

Svrha ovog preglednog rada je prikaz timektomije kao oblika liječenja u osoba oboljelih od miastenije gravis. Miastenija gravis je kronična, autoimuna, neuromuskularna bolest karakterizirana slabošću i zamaranjem skeletnih , poprečnoprugastih, mišića. U 80% oboljelih od miastenije gravis nalazi se abnormalnost timusa od čega 10-20% ima timom, a preostali dio hiperplaziju timusa. Timus je parenhimatozni organ sivocrvenkaste boje smješten u prednjem gornjem dijelu medijastinuma, iza prsne kosti. To je središnji organ limfatičnog sustava čija je glavna uloga prethodna obrada limfocita T. Poremećaji u obradi limfocita T imaju ulogu u patogenezi miastenije gravis. Liječenje miastenije gravis je simptomatsko, a cilj liječenja je potpuni nestanak simptoma. Timektomija, uz farmakološko liječenje, predstavlja oblik terapije za oboljele od miastenije gravis. Timektomijom se želi postići značajno poboljšanje simptoma kod bolesnika, prvenstveno smanjiti slabost mišića, zatim u najvećoj mogućoj mjeri reducirati farmakološku terapiju te u idealnom slučaju postići potpunu remisiju bolesti. Više različitih čimbenika, kao što su dob i spol bolesnika, težina simptoma, prisutnost timoma, prisutnost protutijela na AChR ili MuSK receptore, oblik bolesti, pa čak i trudnoća utječu na odluku o tome da li će osoba biti podvrgnuta timektomiji ili ne.Razlikujemo nekoliko glavnih kirurških pristupa: transcervikalnu, transsternalnu i VATS timektomiju. Nije potvrđeno da VATS timektomija ima veću učinkovitost u remisiji bolesti od transsternalne timektomije, ali minimalno invazivni postupci imaju niže stope morbiditeta i mortaliteta, manji broj komplikacija te je kraće vrijeme oporavka bolesnika.The purpose of this thesis is to present timectomy as a form of treatment in people suffering from myasthenia gravis. Myasthenia gravis is a chronic, autoimmune, neuromuscular disease characterized by weakness and fatigue of skeletal muscles. In 80% of patients with myasthenia gravis there is an abnormality of thymus, of which 10-20% has a thymoma, and the rest of them the thymus hyperplasia. Timus is a parenchymal organ of reddish-brown color placed in the front upper part of the mediastinum behind the chest bone. It is the central organ of the lymphatic system whose main role is the prior processing of lymphocytes T. Thymus plays a role in the pathogenesis of myasthenia gravis. The treatment of myasthenia gravis is symptomatic, and the goal of treatment is complete disappearance of symptoms. Timectomy, along with pharmacological treatment, is a form of therapy for people suffering from myasthenia gravis. Timectomy seeks to significantly improve clinical symptoms of the patient, primarily to reduce the muscle weakness, then to reduce the pharmacological therapy and ideally achieve complete remission of the disease. Multiple factors, such as age and sex, symptom weight, thymoma presence, presence of antibodies to AChR or MuSK receptors, the form of the disease, and even the pregnancy, influence the decision whether or not the subject will be operated. Major surgical approaches are: transcervical, transcernal, and VATS timectomy. It has not been shown that VATS timectomy has greater efficacy in remission of myasthenia gravis, but minimal invasive procedures have lower rates of morbidity and mortality, fewer complications, and shorter recovery time of the patient