MYASTENÝA GRAVÝSTE TÝMEKTOMÝ

Myastenia gravis (MG) nöromüsküler kavþaðýn otoimmün bir hastalýðýdýr. Medikal tedaviden yarar görmeyen ya da yüksek ilaç dozlarýna gerek duyulan olgularda timektomi hastalýðýn regresyonuna katkýsý olan bir tedavi yöntemidir. Kliniðimizde 2003-2006 yýllarý arasýnda MG nedeniyle timusa yönelik cerrahi müdahale yapýlan yedi olgu retrospektif olarak deðerlendirildi. Olgularýn dördü kadýn, üçü erkek ve yaþ ortalamasý 40.2 (20 ile 58 arasýnda) idi. Tüm olgularda myastenik semptomlar mevcuttu. Olgularýn nörolojik tedavileri yapýlmýþ ve klinik tablo kontrol altýna alýnmýþtý. Tüm olgular antikolinesteraz, iki hasta ek olarak kortikosteroid kullanýyordu. Tüm olgular intravenöz immunoglobulin tedavisi görmüþtü. Olgularýn altýsýna median sternotomi ile ekstended timektomi, nüks malign timomalý bir hastaya ise torakotomi ile timektomi uygulandý. Bir hasta postoperatif 30. günde kaybedildi. Ortalama takip süresi 15.4 aydý (6-36 ay). Üç hastada remisyon, bir hastada parsiyel yanýt, iki hastada ise stabil yanýt saptandý. Komplikasyon izlenmedi. Sonuç olarak; ekstended timektomi ile MG' li olgularda olgularýn yaþam kalitesi artar. Komplet remisyon saðlanabilir. Myastenik olgularda ekstended timektomi ile alýnan iyi sonuçlar, bu giriþimin önerilebilecek bir yöntem olduðunu göstermektedir.

THYMECTOMY FOR MYASTHENIA GRAVIS

Myasthenia gravis (MG) is an autoimmun disease of neuromusculer junction. Thymectomy provides higher rate of remission to the patiens who had not benefit from medical treatment or needed higher drug dosages. Between 2003-2006, seven cases with MG treated by timus surgery with our clinic were studied retrospectively. Four cases were female and mean age was 40.2 (range 20 to 58). All cases had generalized myasthenic symptoms. Cases have been treated by neurologist and they were clinical stable. All cases were administered anticholinesterase therapy and two cases were taking corticosteroid drug additionally. All cases were administered intravenous immunoglobulin therapy preoperatively. We performed extended thymectomy via median sternotomy for the six of the cases, and thoracomy in one case, because of recurrens of malign timoma. One patient died at the 30th day after surgery. The follow up period was 15.4 (Range 6 to 13) months. Complet remission was seen in three cases and partial remission in one. Two cases were stable. As a result; extended thymectomy improves the quality of life. It may also provide complet remission. We obtained good results in our myasthenic cases by extended thymectomy. We believe that this procedure may be preferable in myasthenic cases.