巨大纵隔畸胎瘤的临床特点和外科治疗

Clinical characteristics and surgical treatment of huge mediastinum teratoma

目的探讨巨人纵隔畸胎瘤的临床特点和外科治疗。方法回顾分析1989年12月至2003年12月我院收治并经病理证实的巨大纵隔畸胎瘤36例患者的临床资料。结果本组男21例，女15例。年龄13—63岁，其中35岁以下3l例。病变位于左前纵隔者14例，右前纵隔22例。肿瘤最大直径10—15cm 21例，15～20cm 9例，〉20cm 6例。肿痛外穿10例，其巾继发肺感染6例，胸腔感染2例，心包感染1例。病理证实囊性畸胎瘤25例，文性畸胎瘤11例，其中3例镜检有恶性细胞，诊断为恶性畸胎瘤。肿瘤完整切除34例，次仝切除2例，其中合并前外侧心包大部切除4例，合并肺叶切除3例，不规则肺叶切除2例，右全肺1例。结论巨人纵隔畸胎瘤临床和X线CT表现复杂，外侵和粘连严重，手术治疗时应注意切口和术式的选择，严防术中意外出血。

Objective To oxplore the clinical characteristics and surgical treatment of huge mediastinum teratoma. Methods The clinical materials of 36 pathologically proved huge mediastinum teratoma from Deccn,ber 1989 to December 2003 in this hospital were analyzed retrospectively. Results In this group,21 were men and 15 women aged 13-63 years,with 31 under the age of 35. The number of the patients whose tumors were situated in left anterior n,ediastinum was 14, while 22 patients had tumors situated in right anterior mediastinum. The tumors with largest dian,cter 10-15 cm were found in 21 cases, 15-20 cm in 9 cases, greater than 20 cm in 6 cases. The tumor invaded outside in 10 cases,of whom,6 had secondary infection of lung,2 had infection of pleural cavity and 1 had infection of pericardium, pathological examination confirmed cystic teratoma in 25 cases, solid teratoma in 11 cases, 3 of whom had malignant cells and were diagnosed as malignant teratoma. The tumors were reseeted totally in 34 cases, subtotally in 2 cases. Resection including large part of antero-lateral pericardium was performed in 4 cases,that including lobectomy of lung,irregular lobectomy of lung and right total pneumonectomy in 3 cases,2 cases and 1 case respectively. Conclusions The clinical and CT manifestations of huge mediastinum teratoma are complicated. It invades outside and causes severe adhesion. Attention should be paid to selection of incision and operation approach during surgical treatment and prevention of accidental bceding during operation.