Rol de la Timectomía Toracoscópica en el Manejo de la Miastenia Gravis
Fecha
2023
Tipo
tesis
Autores
Gamboa Pacheco, Carlos Andrés
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Resumen
La miastenia gravis es una enfermedad autoinmune de la transmisión neuromuscular, que puede afectar la calidad de vida de los pacientes e incluso, comprometerla si no es tratada. Se caracteriza por desarrollar debilidad muscular progresiva y fatiga de los músculos esqueléticos voluntarios y en la mayoría de pacientes se presenta como ptosis y diplopía.
Se cree que el timo es la glándula que juega un rol importante en la patogénesis de la miastenia, principalmente por una respuesta autoinmune que produce auto anticuerpos contra los receptores de acetilcolina o como síndrome paraneoplásico secundario a algunas neoplasias.
El tratamiento médico es pivote en el manejo de esta enfermedad, sin embargo, se ha aceptado la timectomía como opción terapéutica con buenos resultados en cuanto a disminución de síntomas, progresión de la enfermedad o reducción en el uso de fármacos y por ende, menos efectos adversos.
Se han propuesto diversos abordajes quirúrgicos para la resección de la glándula, desde los más invasivos hasta la aplicación de la cirugía mínimamente invasiva con los beneficios que esta conlleva; el abordaje ideal aún es un tema controversial.
Como denominador común mostrado en diversos estudios, la extirpación total de la glándula en conjunto con el tejido adyacente, es el objetivo principal del manejo quirúrgico y el determinante en el control de la enfermedad.
Myasthenia gravis is an autoimmune neuromuscular transmission disorder, which can affect patients’ quality of life or even threaten it if left untreated. This disorder is characterized by progressive weakness and fatigue of voluntary skeletal muscles and most patients present with ptosis and diplopia. It is believed that thymus gland plays an important role in the pathogenesis of myasthenia, mediated by an autoimmune response because of autoantibodies against the acetylcholine receptors or as a paraneoplastic syndrome secondary to a tumor. The medical therapy is mainstream in the treatment of this disease, although thymectomy has been accepted as a therapeutic option with great results reducing symptoms, disease progression or lowering drug doses and side effects. It has been proposed diverse surgical techniques for the gland resection, from the most invasive to the application of the minimal invasive techniques with their known benefits; the ideal approach still remains controversial. Studies has shown that the total resection of the gland with the adjacent tissue is the main goal of the surgery and it is what will determine the outcomes.
Myasthenia gravis is an autoimmune neuromuscular transmission disorder, which can affect patients’ quality of life or even threaten it if left untreated. This disorder is characterized by progressive weakness and fatigue of voluntary skeletal muscles and most patients present with ptosis and diplopia. It is believed that thymus gland plays an important role in the pathogenesis of myasthenia, mediated by an autoimmune response because of autoantibodies against the acetylcholine receptors or as a paraneoplastic syndrome secondary to a tumor. The medical therapy is mainstream in the treatment of this disease, although thymectomy has been accepted as a therapeutic option with great results reducing symptoms, disease progression or lowering drug doses and side effects. It has been proposed diverse surgical techniques for the gland resection, from the most invasive to the application of the minimal invasive techniques with their known benefits; the ideal approach still remains controversial. Studies has shown that the total resection of the gland with the adjacent tissue is the main goal of the surgery and it is what will determine the outcomes.
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CIENCIAS MÉDICAS, CIRUGÍA, TÓRAX