{"title":"[Thoracoscopic thymectomy for myasthenia gravis and non-invasive thymoma after COVID-19 pneumonia].","authors":"E B Topolnitskiy, V V Gusakov","doi":"10.17116/hirurgia202408126","DOIUrl":null,"url":null,"abstract":"<p><p>Modern guidelines have identified thoracoscopic thymectomy as a preferable option for myasthenia gravis and non-invasive thymoma. In the era of the new coronavirus infection, it is relevant to develop protocols for anesthetic and perioperative support of patients undergoing thymectomy for myasthenia gravis after COVID-associated pneumonia (CAP). We present the results of thoracoscopic thymectomies in patients after CAP. Multidisciplinary team should determine therapeutic support, the need for plasmapheresis and thymectomy. Plasmapheresis and glucocorticosteroids are effective in addition to anticholinesterase therapy at the stages of perioperative support for correction of neurological status in patients with myasthenia combined with chronic obstructive pulmonary disease and pulmonary hypertension. Outpatient direct anticoagulants are advisable considering the need for prolonged postoperative prevention of thrombotic events.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 8","pages":"26-33"},"PeriodicalIF":0.0000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Khirurgiya","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.17116/hirurgia202408126","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Modern guidelines have identified thoracoscopic thymectomy as a preferable option for myasthenia gravis and non-invasive thymoma. In the era of the new coronavirus infection, it is relevant to develop protocols for anesthetic and perioperative support of patients undergoing thymectomy for myasthenia gravis after COVID-associated pneumonia (CAP). We present the results of thoracoscopic thymectomies in patients after CAP. Multidisciplinary team should determine therapeutic support, the need for plasmapheresis and thymectomy. Plasmapheresis and glucocorticosteroids are effective in addition to anticholinesterase therapy at the stages of perioperative support for correction of neurological status in patients with myasthenia combined with chronic obstructive pulmonary disease and pulmonary hypertension. Outpatient direct anticoagulants are advisable considering the need for prolonged postoperative prevention of thrombotic events.
现代指南已将胸腔镜胸腺切除术确定为治疗重症肌无力和非侵袭性胸腺瘤的首选方案。在新型冠状病毒感染的时代，为 COVID 相关肺炎（CAP）后因重症肌无力而接受胸腺切除术的患者制定麻醉和围手术期支持方案具有重要意义。我们介绍了胸腔镜胸腺切除术在 CAP 患者中的应用效果。多学科团队应确定治疗支持、血浆置换和胸腺切除术的必要性。在肌无力合并慢性阻塞性肺疾病和肺动脉高压患者围手术期支持治疗阶段，除抗胆碱酯酶治疗外，浆细胞吸出术和糖皮质激素对纠正患者的神经状态也很有效。考虑到术后需要长时间预防血栓事件，建议使用门诊直接抗凝剂。
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