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Difficult Decisions in Thoracic Surgery - part 10

Các phương pháp phẫu thuật để thymectomy rất đa dạng và phản ánh mong muốn để thực hiện một cắt bỏ hoàn toàn cân nhắc tầm quan trọng và bệnh suất của thủ tục. Tất cả các phương pháp tiếp cận cho phép cắt bỏ hoàn toàn của tuyến ức vỏ; | 470 J.R. Sonett many years after it was introduced as a therapeutic modality. To help define conclusively the role of thymectomy in nonthymomatous MG a prospective multi-institutional international trial approved for funding by the National Institutes of Health NIH is planned to randomize patients to thymectomy versus medical treatment beginning in 2006.5 57.1.2. Surgical Approaches to Thymectomy The surgical approaches to thymectomy are varied and reflect the desire to perform a complete resection weighed against the magnitude and morbidity of the procedure. All approaches enable complete resection of the capsular thymus what differentiates the approaches are the extent of peri-thymic mediastinal and cervical tissue that are excised. To help understand the different approaches to thymectomy and categorize the extent of resections the Myasthenia Gravis Foundation of America MGFA has broadly classified varying techniques of resection based on the operative approach and extent of surgical resection Table 57.1 .6 7 In the ever dynamic surgical field robotic approaches T-2 a as well as bilateral thoracoscopic approaches T-2 b are evolving. Overall individual case series have reported data that support the validity and success of all the approaches however the lack of prospective case controlled studies do not provide a significant level of evidence that one thymectomy technique is superior.4 There is insufficient evidence to determine which thymectomy technique is superior in the management of myasthenia gravis. Table 57.1. Myasthenia Gravis Foundation of America MGFA thymectomy classification.6 7 T-1. Transcervical thymectomy a. Basic b. Extended T-2. Videoscopic thymectomy a. VATS b. VATET T-3. Trans-sternalt hymectomy a. Standard b. Extended T-4. Transcervical and trans-sternal thymectomy Given the lack of definitive case controlled and prospective studies this evidence-based review will highlight selective studies that are reported by established centers in the .