Die transsternale Thymektomie

The transsternal thymectomy. Indication of operation and perioperative management

Summary

Between 1985 and 1998 42 transsternal thymectomies were performed. The median duration of symptoms in myasthenia gravis patients (n = 27, 25/27 patients in stadium I/II of the Ossermann classification) was 40.3 weeks and 70.8 days between first diagnosis and operation. In 12 patients a thymoma was found (11/12 patients with stadium I/II of Masaoka classification), which was associated with myasthenia gravis symptoms in 10 cases. In 3 patients thymic tumors of other origin were verified histologically. After sugery these patients have an increased risk of pulmonary complications. We changed 1996 the perioperative anesthesiological procedure using total intravenous anesthesia with propofol/remifentanil and systemic patient - controlled analgesia with piritramid in the first two days after transsternal thymectomy. This mangement allows a quick extubation after operation and improved lung function postoperatively.

Zusammenfassung

Zwischen 1985 und 1998 wurden 42 transsternale Thymektomien durchgeführt. Bei Patienten mit einer Myasthenia gravis (n = 27) betrug die durchschnittliche Dauer der Symptomatik bis zur Erstdiagnose 40,3 Wochen (25/27 Patienten in Stadium I und II nach Ossermann) und weitere 70,8 Tage bis zur operativen Therapie. Bei 12 Patienten fand sich ein Thymom (11/12 im Stadium I und II nach Masaoka), das in 10 Fällen mit einer begleitenden Myasthenia gravis Symptomatik einherging. In 3 Fällen fanden sich Thymustumore anderer Genese. In der postoperativen Phase besteht bei diesen Patienten ein erhöhtes pulmonales Risiko, das sowohl in der Narkoseführung als auch in der postoperativen Schmerztherapie berücksichtigt werden muß. Nach Umstellung des Narkoseverfahrens (1996) auf die totale intravenöse Anästhesie mit Propofol/Remifentanil und die routinemäßige Piritramid-Gabe über die PCA-Pumpe wurden keine pulmonalen Komplikationen mehr beobachtet.

Key words

Myasthenia gravis - thymoma - transsternal thymectomy - Propofol - patient-controlled analgesia

Schlüsselwörter

Myasthenia gravis - Thymom - transsternale Thymektomie - Propofol - Analgesie

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