Chirurgische Therapieverfahren bei Erkrankungen des Thymus

Zusammenfassung

Die Thymusdrüse ist Ausgangspunkt von nichttumorösen, häufig autoimmun bedingten Erkrankungen und Tumoren. Die wichtigste und einzig chirurgisch relevante nichttumoröse Erkrankung des Thymus ist die Myasthenia gravis (MG). Diese durch abnormal schnelle Ermüdbarkeit variabler Willkürmuskeln charakterisierte Erkrankung gilt als die am besten erklärte autoimmun bedingte Erkrankung überhaupt. Hier besteht eine relative Indikation zur Durchführung einer kompletten Thymektomie (Thx). Für die chirurgische Therapie relevante Raumforderungen des Thymus sind exklusiv die epithelialen Tumoren des Thymus. Im engeren Sinn sind das die Thymome und Thymuskarzinome. In jedem Fall ist dabei eine radikale Thx absolut indiziert. Es kommen zahlreiche unterschiedliche Operationstechniken zur Anwendung, wobei einerseits das Postulat der Notwendigkeit einer radikalen Thx und andererseits das Streben nach minimaler Invasivität des Eingriffes die Diskussion um die optimale Operationstechnik zur Thx bestimmen.

Abstract

The thymus gland is the origin of non-tumorous, frequently autoimmunological diseases and tumors. The most important and only non-tumorous disease of the thymus with surgical relevance is myasthenia gravis (MG). This disease is characterized by an abnormal fatigability of varying voluntary muscles and seems to be the best explained autoimmune disease at all. There is a relative indication for complete thymectomy (Thx) in these cases. Of the space- occupying lesions only epithelial thymic tumors are of surgical relevance. These tumors comprise thymomas and thymic carcinomas. Each of these cases absolutely requires a radical Thx. Many different operation techniques for Thx are performed. The ongoing debate on the optimal operation technique for Thx is determined by the necessity of radicality and the attempt at minimal invasion of surgery.

Schlüsselwörter

Thymektomie - Myasthenia gravis - Thymom - minimal-invasiv - roboter-assistiert

Key words

Thymectomy - myasthenia gravis - thymoma - minimally-invasive - robotic-assisted

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