摘要
目的：探讨原发性纵隔肿瘤及囊肿的诊断和外科治疗，特别是术中防治意外损伤及保证手术安全的技术问题。方法：对我院手术治疗的原发性纵隔肿瘤及囊肿272例患者的临床资料进行分析。结果：272 例中 神 经源性肿瘤占28.3%，其次为胸腺肿瘤或囊肿（27.6%）和畸胎样瘤（20.2%）；X线检查与术后病理诊断的基本符合率为73.9%（201例）；均在全麻下施行手术，其中开胸手术266例，经颈部手术4例，颈胸分别切口同期手术2例；手术方式包括肿瘤或囊肿完全切除、大部切除和开胸探查等。术中上腔静脉损伤4例，其中1例经右心耳上腔静脉插管后修补，二期（术后2周）拔除上腔静脉插管治愈。手术死亡6例，手术死亡率为2.2%。结论：在原发性纵隔肿瘤及囊肿中，神经源性肿瘤的发病率居首位，其次为胸腺瘤和畸胎样瘤；胸部X线检查是诊断本病的主要手段；充分的围手术期处理，认真选择切口，在手术操作中防治重要组织器官损伤是保证手术安全的关键。
Objective: To explore the diagnosis and surgical treatment of primary mediastinal tumors and cysts(MTC) and the operative technique in preventing and dealing with the unexpected trauma during the operation. Methods: Two hundred and seventy-two operative patients with primary MTC were studied and analyzed. Results: Of the 272 patients, there were 77(28.3%) neurogenic tumors, 75(27.6%) thymomas and 55(20.2%) teratodermoids respectively .The corresponding rate between preoperative X-ray examination and postoperative pathological examination was 73.9%.All the patients were operated through thoracotomy(266 cases), cervical incision(4 cases), cervical and sternotomy(2 cases) under general anaesthesia .The operative models included total resection,subtotal resection and exploration, etc. Four unexpected traumas to the superior vena cava happened, and 1 of them was repaired via an interal shunt inserted into the superior vena cava through the right atrial appendage of the heart,and cured by taking out the shunt after 2 weeks.There were 6 operative death cases (2.2%). Conclusion: Neurogenic tumor heads the list of the study, thymoma is the second and teratodermoid is the third.Chest X-ray examination is the common access to diagnose primary MTC. It is crucial for surgeons to ensure the security of the operation through satisfactory peroperative treatments, choosing correct incisions , preventing and curing trauma to the vital organs during operation.
出处
《重庆医科大学学报》
CAS
CSCD
2001年第1期89-91,共3页
Journal of Chongqing Medical University
关键词
纵隔肿瘤
囊肿
诊断
外科治疗
Mediastinum；Tumor；Cyst；Diagnosis；Surgical treatment
