VATS THYMECTOMY IN MYASTHENIA GRAVIS TREATMENT – A CASE REPORT
Autori:
Dragan Krnić, Joško Juričić, Nenad Ilić, Antonio Jerčić
Sažetak
Miastenija gravis (MG) kronična je autoimunosna bolest karakterizirana slabošću skeletnih mišića, osobito bulbomotornih. Povezanost između timusa i MG-a još nije potpuno jasna. Timektomija se preporučuje u osoba s timomom, a treba ju uzeti u obzir kod bolesnika s generaliziranim MG-om mlađih od 60 godina kod kojih nije dokazan timom. U radu smo prikazali slučaj 27-godišnje žene oboljele od okularnog tipa MG-a s radiološki potvrđenom tvorbom prednjeg medijastinuma koju smo podvrgli zahvatu torakoskopske timektomije. Zahvat smo izveli pristupom kroz desno prsište uz uporabu triju troakara. Prostor za rad osigurali smo primjenom dvolumenskog tubusa i insuflacijom CO2. Za disekciju i ligaciju rabili smo ultrazvučni rezač. Postoperacijski oporavak protekao je bez komplikacija te je bolesnica otpuštena treći poslijeoperacijski dan. Prikazali smo ovu bolesnicu kako bismo upozorili na brži oporavak i bolji kozmetički efekt kod primjene VATS-a u odnosu prema sternotomijskim postupcima.
Summary
Myasthenia gravis (MG) is a chronic autoimmune disease characterized by weakness of skeletal muscles, specifically ocular. Relationship between the thymus gland and MG is not fully understood yet. Thymectomy is recommended for individuals with thymoma, but should be considered in all patients under 60 years of age with generalized MG in cases with no thymomatous tissue. We report a 27-year-old female patient with ocular type myasthenia gravis and radiological findings of anterior mediastinal mass, treated by VATS thymectomy. The intervention was carried out by 3-portal right-sided thoracoscopic approach. Single-lung ventilation and carbon-dioxide insufflation provided working space, and harmonic scalpel was used for the dissection and ligation. The patient’s postoperative course was uncomplicated and the patient was discharged on the third postoperative day. The aim of our case report is to stress the importance of VATS technique in faster recovery and better cosmetic effect than in sternotomy procedures.
