Myasthenia gravis: surgical resection of the thymus is not enough

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Author: Cheng Lifeng correspondent: Shen LinInterviewed experts: the First Affiliated Hospital of Zhongshan University, East Hospital cardio


Author: Cheng Lifeng correspondent: Shen Lin

Interviewed experts: the First Affiliated Hospital of Zhongshan University, East Hospital cardiothoracic surgery director Chen Zhenguang, MD, chief physician

Many years ago, the TV drama "falls", let many people know of this disease in patients with myasthenia gravis. The hero of the play in the symptoms of the car can not hang up, hands can not afford a cup, a lot of drugs do not work, and ultimately even death due to myasthenia gravis. Suffering from myasthenia gravis as an incurable disease.

So, myasthenia gravis is not really can not be treated? In this regard, the First Affiliated Hospital of Zhongshan University, East Hospital cardiothoracic surgery director Chen Zhenguang. He pointed out that the current medicine that thymus derived antibodies is a major cause of myasthenia gravis, suggest first surgical treatment, with standard medical treatment, multidisciplinary team treatment scheme therefore require surgical advance.

The variety of myasthenia gravis

Myasthenia gravis is a neuromuscular transmission disorder acquired autoimmune disease with involvement of skeletal muscle fatigue easily, after aggravating, the rest and application of anti cholinesterase drugs improve symptoms characteristics.

Ptosis is often the first of many patients with myasthenia gravis, but in addition, diplopia, strabismus, dysphagia, bucking, unable to speak, pronunciation, and fatigue, shrug weakness, difficulty breathing, may be symptoms of myasthenia gravis, and swallowing, drinking water, pronunciation, respiratory etc. the symptoms are more serious illness performance.

According to Professor Chen Zhenguang, who is a patient with dysphagia symptoms at a number of hospitals, and began to think of esophageal tumor, repeatedly done gastroscopy, but did not find any abnormality; after intramuscular injection of neostigmine (a medicine called neostigmine test), difficulty swallowing immediately ease, just know originally had myasthenia gravis.

Treatment: first operation, re medication

At present, the treatment of myasthenia gravis is usually drugs and surgery. In accordance with the thinking of the general people, all want to use the drug treatment, if not, then surgery. But in fact, the general treatment order should be the first surgical treatment, and then given standardized drug treatment". Professor Chen Zhenguang pointed out that the thymus is the cause of myasthenia gravis disease causes. Surgical removal of the thymus can avoid the production of acetylcholine receptor antibody, which is an effective means to block the pathological process of myasthenia gravis, and is the first choice for the treatment of myasthenia gravis. Myasthenia gravis is not an incurable disease, the disease of foreign already have standard treatment options, multidisciplinary treatment is actually need surgery first. Active surgical treatment, combined with internal medicine, Chinese medicine cooperation, close to 80% of patients can get better results.

However, the removal of the thymus alone is not enough. Professor Chen Zhenguang warned that the scope of surgical resection should include the thymus and its surrounding adipose tissue, because there is a certain probability of ectopic thymus tissue surrounding the thymus tissue". According to Professor Chen Zhenguang, statistics of the more than 2 thousand cases of myasthenia gravis patients and the clinical data, found that there are around 30% ectopic thymus thymic adipose tissue, even in other parts of the anterior mediastinum have ectopic thymus. Because of this, in foreign countries, surgical removal of the thymus at the same time actively, thoroughly clean the surrounding adipose tissue, has long been a routine, Professor Chen Zhenguang said.

In general, 2 to 4 years after surgery is the peak period of remission. Therefore, the need for medical treatment after surgery. Professor Chen Zhenguang reminded, "just outside the surgical treatment as a part of the treatment for postoperative symptoms, even if not, do not rush to stop, but should be based on the index of blood tests to determine whether the drug reduction or withdrawal, rush withdrawal often leads to illness."

Diet should not be cold

Many people hope that the treatment of traditional Chinese medicine, which, Chen Zhenguang believes that after surgery can continue to take traditional Chinese medicine treatment, but should pay attention to.

He pointed out that, in the Chinese view, myasthenia gravis is deficiency, therefore, postoperative and usually are not eating cold food, such as watermelon, melon, and herbal tea, soft drinks, can be appropriate to eat some hot food, also can eat ginseng, dangshen, astragalus; such as thymoma, you can also take letinous edodes, Ganoderma lucidum enhance the immunity of food.

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