Surgical treatment of myasthenia gravis

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Myasthenia gravis is a neurological disease, the major clinical manifestations after repeated muscle weakness or fatigue, rest after symptom

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Myasthenia gravis is a neurological disease, the major clinical manifestations after repeated muscle weakness or fatigue, rest after symptoms, it is a kind of autoimmune disease, a large body of evidence has accumulated that myasthenia gravis is an autoimmune disease, the patients in the motor endplate acetylcholine antibody. Antibodies against motor neurons and peripheral skeletal muscle cells formed, especially postsynaptic acetylcholine receptors, the number of functional acetylcholine receptors decreases as a result of the action potential obstacles, but to neuromuscular transmission disorder. Thus symptoms.

Myasthenia gravis is susceptible to young and old men, with an average age of 26 years. Almost any body muscles are involved, ocular myasthenia gravis is the most frequently involved muscles, the typical symptoms of myasthenia gravis early paroxysmal weakness and progressive increase over time. Early symptoms are usually confined to the eye, but more than 80% ocular patients at the onset of 1 years can be developed into a systemic weakness, the performance of the whole body muscle involvement, activity limitation, some patients eventually died of respiratory muscle involvement and death.

Since 1901, people began to pay attention to the relationship between myasthenia gravis and thymus, now think in this process of autoimmune diseases in the thymus plays an important role in: a more than 80% of the patients, especially young patients with thymoma or thymus hyperplasia; two in the thymus of patients with myasthenia gravis found to have anti AChR antibody and antibodies against other striated muscle antigen; three, thymectomy has good curative effect.

The treatment includes drug treatment and surgical treatment, each has advantages and disadvantages, generally only can take early non operative therapy, once the illness or development of generalized myasthenia gravis, then select thymectomy is the best, because of the existence of good prognosis and avoid the possibility of additional treatment drugs. Drug therapy, anti cholinesterase drugs: the most commonly used drugs for neostigmine and pyridostigmine bromide, the use of other drugs such as corticosteroids for treatment or removal of the plasma in the plasma of patients with specific factors and acetylcholine antibodies by plasma exchange; and the joint or the use of immunosuppressive agents alone often can only achieve clinical the efficacy of. Surgical treatment, the thymus in myasthenia gravis pathogenesis, development and prognosis of the important position, current surgical treatment to thymectomy mainly has become the preferred treatment, Transsternal thymectomy in the past, extended thymectomy, due to its complex operation and surgical trauma, in clinical use has become less and less,

In particular, due to the clinical application of video-assisted thoracoscopic surgical technique, thoracoscopic thymectomy mature, because the thoracoscopic surgery can be curative effect and thoracotomy in exactly the same, and minimally invasive thoracoscopic surgery, can the hospitalization time significantly shortened hospitalization the cost is relatively reduced, so the thoracoscopic thymectomy and traditional operation mode has the advantages of surgical treatment has become There is nothing comparable to this, the preferred method of myasthenia gravis.

After thymectomy treatment, most patients can achieve remission of clinical symptoms, recovery of daily life and work ability, even if there is a small part of the patient's symptoms of recurrence after a period of time after treatment again and still get some relief.

 

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