{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2022,6,22]],"date-time":"2022-06-22T16:11:18Z","timestamp":1655914278134},"reference-count":0,"publisher":"Akademiai Kiado Zrt.","issue":"4","content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["MaSeb"],"published-print":{"date-parts":[[2020,12,12]]},"abstract":"\u00d6sszefoglal\u00f3.<\/jats:bold>\n Bevezet\u00e9s:<\/jats:italic> A myasthenia gravis javallat\u00e1val v\u00e9gzett\n csecsem\u0151mirigy-elt\u00e1vol\u00edt\u00e1s seb\u00e9sztechnikai szempontb\u00f3l l\u00e9nyegesen megv\u00e1ltozott\n az elm\u00falt k\u00f6zel 30 \u00e9vben. A standard m\u0171t\u00e9tnek sz\u00e1m\u00edt\u00f3 transsternalis \u00e9s\n transcervicalis thymectomia mellett elterjedt a videoassziszt\u00e1lt thoracoscopos\n seb\u00e9szeti (VATS), k\u00e9s\u0151bb pedig a robot seb\u00e9szeti megold\u00e1s is. K\u00e9t int\u00e9zet\u00fcnkben\n 2011\u20132012-ben vezett\u00fck be a VATS thymectomi\u00e1t. M\u00f3dszer:<\/jats:italic> A\n t\u00f6bbf\u00e9le technikai megold\u00e1s k\u00f6z\u00fcl a mediastinumot a jobb mell\u00fcreg fel\u0151l\n megk\u00f6zel\u00edt\u0151 utat v\u00e1lasztottuk. Eleinte 3, k\u00e9s\u0151bb 2 pontos perimammaris portot\n k\u00e9sz\u00edtett\u00fcnk a thymus el\u00e9r\u00e9s\u00e9re a beteg h\u00e1ton fekv\u0151 helyzet\u00e9ben. Minden esetben\n ultrahangos v\u00e1g\u00f3eszk\u00f6zt alkalmaztunk. Kiterjesztett thymectomi\u00e1ra t\u00f6rekedve a\n perithymikus zs\u00edrsz\u00f6vetet is elt\u00e1vol\u00edtottuk, sz\u00e9lesen megnyitva a bal oldali\n mell\u00fcreget is. A betegek kiv\u00e1laszt\u00e1s\u00e1ban az \u00e1tlagos tests\u00faly\u00fa vagy sov\u00e1nyabb\n betegeket r\u00e9szes\u00edtett\u00fck el\u0151nyben. Eredm\u00e9nyek:<\/jats:italic> 8 \u00e9v \u00e9s 4 h\u00f3nap\n alatt 92 beteget m\u0171t\u00f6tt\u00fcnk a fenti m\u00f3dszerrel thymoma n\u00e9lk\u00fcli myasthenia gravis\n alapbetegs\u00e9ggel. 20 f\u00e9rfi \u00e9s 72 n\u0151. \u00c1tlag\u00e9letkor 33,1 \u00e9v (19\u201375 \u00e9v). A m\u0171t\u00e9ti\n id\u0151 35\u2013160 percig terjedt, \u00e1tlagosan 82,3 perc volt. A t\u00f6megesebb mediastinalis\n zs\u00edrsz\u00f6vet n\u00e9h\u00e1ny betegn\u00e9l nehez\u00edtette a t\u00e1j\u00e9koz\u00f3d\u00e1st \u00e9s a marad\u00e9ktalan\n elt\u00e1vol\u00edt\u00e1st. M\u0171t\u00e9t alatt 4 esetben \u00e9rs\u00e9r\u00fcl\u00e9s \u00e9s 3 ellenoldali t\u00fcd\u0151s\u00e9r\u00fcl\u00e9s\n k\u00f6vetkezett be. K\u00e9t konverzi\u00f3t v\u00e9gezt\u00fcnk (1-1 sternotomia \u00e9s thoracotomia).\n Idegs\u00e9r\u00fcl\u00e9s nem t\u00f6rt\u00e9nt. T\u00edz beteg ig\u00e9nyelt n\u00e9h\u00e1ny \u00f3r\u00e1s m\u0171vi l\u00e9legeztet\u00e9st a\n m\u0171t\u00e9t ut\u00e1n, a t\u00f6bbi beteget a m\u0171t\u0151asztalon extub\u00e1ltuk. Reintub\u00e1ci\u00f3,\n tracheostomia, l\u00e9gz\u00e9si el\u00e9gtelens\u00e9g, m\u0171t\u00e9ti hal\u00e1loz\u00e1s nem volt. Az intenz\u00edv\n \u00e1pol\u00e1si id\u0151 \u00e1tlaga: 1,1 (0\u201311) nap. A teljes k\u00f3rh\u00e1zi \u00e1pol\u00e1si id\u0151 \u00e1tlaga: 4,8\n (3\u201315) nap. A dren\u00e1zsid\u0151 1\u20134 nap, \u00e1tlagosan 1,16 nap. K\u00e9t beteg (2,41%) halt meg\n a m\u0171t\u00e9tet k\u00f6vet\u0151en 1 \u00e9s 5 \u00e9ven bel\u00fcl. Tov\u00e1bbi 81 beteg 12\u2013108 (\u00e1tlag: 48)\n h\u00f3napos k\u00f6vet\u00e9se sor\u00e1n a myastheni\u00e1s \u00e1llapotban 21 (25,3%) betegn\u00e9l komplett, 4\n (4,82%) betegn\u00e9l gy\u00f3gyszeres remisszi\u00f3, 20 (24,1%) betegn\u00e9l minim\u00e1lis\n manifeszt\u00e1ci\u00f3, 28 (33,73%) betegn\u00e9l egy\u00e9b javul\u00e1s volt meg\u00e1llap\u00edthat\u00f3. 4 (4,82%)\n beteg \u00e1llapota v\u00e1ltozatlan maradt, 4 (4,82%) beteg\u00e9 pedig romlott.\n K\u00f6vetkeztet\u00e9s:<\/jats:italic> A VATS thymectomia teljesen \u00faj utat jelent a\n transsternalis m\u00f3dszerben j\u00e1ratos seb\u00e9szek sz\u00e1m\u00e1ra. A t\u00f6megesebb mediastinalis\n zs\u00edrsz\u00f6vet nagyon megnehez\u00edti a m\u0171t\u00e9tet. A perioperat\u00edv szak nagyon kedvez\u0151 a\n betegek sz\u00e1m\u00e1ra, \u00e9s a k\u00e9s\u0151i eredm\u00e9nyek is elfogadhat\u00f3ak. K\u00e9rd\u00e9ses, hogy a thymus\n minden esetben marad\u00e9ktalanul elt\u00e1vol\u00edthat\u00f3-e ezzel a m\u00f3dszerrel.<\/jats:p>\n Summary.<\/jats:bold>\n Introduction:<\/jats:italic> Surgical technique of thymectomy performed for\n treatment of myasthenia gravis has considerably changed in the last almost 30\n years. In addition to standard interventions \u2013 transsternal and transcervical\n thymectomy \u2013, video-assisted thoracoscopic interventions (VATS), later on\n robotic surgery came into general use. In our two institutions, we apply VATS\n thymectomy since 2011. Methods:<\/jats:italic> There are several different\n surgical techniques for this purpose; we approached the mediastinum through the\n right thoracic cavity. We prepared initially 3, later on 2 perimammal ports for\n the access of the thymus; the patients were in supine position during surgery.\n We used an ultrasonic cutting device in all cases. In order to perform extended\n thymectomy, we removed the fatty tissue around the thymus and opened widely the\n left thoracic cavity, too. During patient enrollment, we preferred patients with\n normal or lower body weight. Results:<\/jats:italic> During 8 years and 4\n months, we operated on 92 patients using this method for myasthenia gravis\n without thymoma; there were 20 male and 72 female patients at the age of 33\n years on average (19\u201375 years). Duration of surgery was 35\u2013160 minutes, 82.3\n minutes on average. The bulky fatty tissue around the thymus made the\n orientation and the complete removal more difficult in a few patients. We\n experienced vascular injury in 4 cases and injury of the contralateral lung in 3\n cases. Conversion was necessary in 2 cases (1 sternotomy and 1 thoracotomy),\n there were no nerve injuries. Assisted ventilation was necessary in case of ten\n patients in the postoperative period for a few hours; all other patients were\n extubated on the operating table. There was no need for repeated intubation and\n tracheostomy; there was no respiratory insufficiency and perioperative\n mortality. Duration of ICU care was 1.1 days on the average (0\u201311 days), that of\n the total hospital care 4.8 days on average (3\u201315 days). Duration of thoracic\n drainage was 1.16 days on average (1\u20134 days). Two patients (2.41%) died within\n one and five years after surgery. During 12\u2013108 months (48 months on average)\n follow-up of 81 patients, 21 patients (25.3%) suffering from myasthenia total\n recovery was observed, pharmacologic remission was achieved in 4 patients\n (5.3%), minimal manifestation remained in 23 patients (24.1%), while in 28\n patients (33.73%) other improvement was observed. The status of 4 patients\n (4.82%) remained unchanged and that of 4 patients (5.3%) worsened.\n Conclusion:<\/jats:italic> VATS thymectomy represents a completely new\n surgical method for surgeons having experience in transsternal surgical\n technique. Bulky mediastinal fatty tissue makes surgery very difficult. The\n perioperative period is advantageous for the patients and also the long term\n follow-up results are acceptable. It is questionable that the thymus can be\n completely removed with this method in all cases.<\/jats:p>","DOI":"10.1556\/1046.73.2020.4.1","type":"journal-article","created":{"date-parts":[[2020,12,26]],"date-time":"2020-12-26T03:11:47Z","timestamp":1608952307000},"page":"125-139","update-policy":"http:\/\/dx.doi.org\/10.1556\/policypage.crossmark.crossref.1","source":"Crossref","is-referenced-by-count":1,"title":["Jobb oldali videoassziszt\u00e1lt thoracoscopos thymectomia a thymoma n\u00e9lk\u00fcli, feln\u0151ttkori myasthenia gravis seb\u00e9szi kezel\u00e9s\u00e9ben"],"prefix":"10.1556","volume":"73","author":[{"given":"J\u00f3zsef","family":"Kas","sequence":"first","affiliation":[{"name":"1 Orsz\u00e1gos Kor\u00e1nyi Pulmonol\u00f3giai Int\u00e9zet, 1121 Budapest, Kor\u00e1nyi Frigyes \u00fat 1."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Levente","family":"Bogy\u00f3","sequence":"additional","affiliation":[{"name":"2 Orsz\u00e1gos Onkol\u00f3giai 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