摘要
目的总结巨大纵隔肿瘤的治疗经验。方法巨大纵隔肿瘤病人31例。根据肿瘤的位置、生长方向和与周围组织的关系,采用不同的手术入路和方式:3例T形切口入路手术,5例Hemi-clamshell切口手术,23例后外侧切口手术。记录围术期相关指标和手术要点。结果良性肿瘤病人17例,恶性肿瘤病人14例。恶性肿瘤病人的平均年龄低于良性肿瘤,平均体积大于良性肿瘤,手术时间、术后带管时间和术后住院时间均长于良性肿瘤,术中出血量大于良性肿瘤,差异均有统计学意义(P <0. 05)。恶性肿瘤需行扩大切除。对于上纵隔巨大恶性肿瘤,推荐采取肿块分块切除的策略。14例恶性肿瘤病人联合手术和辅助化疗,显示了较好的预后。结论手术是巨大纵隔肿瘤首选的治疗方式。恶性肿瘤手术风险更大,充分的术前评估,合理的手术方式,均可获得较好的预后。手术入路的选择和切除技巧是手术成功的关键。
Objective The experience of treating giant mediastinal tumor was summarized.Method A total of 31 patients received radical surgery. The surgical rout was based on the location and growth direction of the tumor,while the surgical mode depended on the involved tissues surrounding the tumor. Three T-shape incisions,5 Hemi-clamshell incisions and 23 posterolateral incisions were performed. The parameters associated with perioperative managements were analyzed. Result 14 malignancies and 17 benign tumors were included. The average age was younger for patients with malignancies than benign tumors( P < 0. 05). The average volume was larger for patients with malignancies than benign tumors( P < 0. 05). The durations of surgery,drainage and stay in hospital were longer for malignancies(P < 0. 05). The bleeding was much more for malignancies(P < 0. 05). Extended tumorectomy were always made for malignancies. Piecemeal resection was suitable for gigantic tumors within superior mediastinum( especially for malignancies). All the malignancies received adjuvant chemotherapy after surgery and achieved good prognosis. Conclusion Surgery was recommended for giant mediastinal tumors. It was sufficient evaluation before surgery and rational surgical strategy that achieved better prognosis. The selectivity of surgical rout and mode was the key to success.
作者
房渝
吴庆琛
秦治明
FANG Yu;WU Qingchen;QIN Zhiming(Department of Thoracic Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《临床外科杂志》
2019年第2期146-148,共3页
Journal of Clinical Surgery
关键词
巨大纵隔肿瘤
手术
预后
恶性
mediastinal tumor
surgery
prognosis
malignancy
