原发性纵隔肿瘤的诊断及外科治疗

Diagnosis and treatment of 238 cases primary mediastinal tumors

目的 :探讨 2 3 8例原发性纵隔肿瘤的诊断及外科治疗经验。方法 :1977年 3月 1日～ 2 0 0 2年 11月 1日经手术治疗且病理证实的原发性纵隔肿瘤及囊肿 2 3 8例。其中胸腺肿瘤 10 4例 ( 4 3 7% ) ,并发重症肌无力 19例 ,发生危象 9例 ;畸胎类肿瘤 3 9例( 16 4% ) ;神经源性肿瘤 3 5例( 14 7% ) ;胸内甲状腺肿 2 6例( 10 9% ) ;纵隔囊肿 17例 ( 7 1% ) ;其他肿瘤 17例 ( 7 1% )。结果 :2 3 8例中彻底切除 2 3 1例 ( 97 0 0 % ) ,7例未能彻底切除者 ,术后给予放疗。术后重症肌无力危象死亡 1例 ( 0 4% ) ,2 3 7例痊愈。结论 :胸部X线及CT检查对纵隔肿瘤的诊断起主要作用 ,手术切除是本病有效的治疗方法。强调早期诊断 ,及时手术 ,对不同部位的肿瘤采取不同入路 ,注意术中特殊情况的处理。

OBJECTIVE:To review the experience of diagnosis and treatment of 238 cases of primary mediastinal tumors. METHODS:Two hundred and thirty eight patients with primary mediastinal tumor were operated and confirmed by pathology upon from March 1977 to November 2002 in our hospital. Among the resected primary mediastinal tumors in this series of patients, the incidence of thymoma was 104 cases( 43.7%), be complicated by myasthenia gravis in 19 cases, occurred crisis in 9 cases, teratoid tumor 39 cases(16.4%),neurogenic tumor 35 cases(14.7%),intrathoracic goiter 26 cases(10.9%),mediastinal cyst 17 cases(7.1%),other kinds of rare tumor 17 cases(7.1%). RESULTS:Total excision in 231 cases (97.00%), partial excision in 7 cases, postoperative performed radiotherapy. There were one postoperative death (0.4%) attributed by asthenia gravis crisis to respiratory failure. The other 237 cases were cured. CONCLUSIONS: mediastinal tumors diagnosis and differentiated take main effect are chest X-ray or CT. At present surgical operation is the effective method for the disease. The importance of early and timely diagnosis of mediastinal tumors was emphasized. Adopt different entrance way according to the tumor location and special treatment during the operation.