跨锁骨和胸骨肿瘤的外科治疗12例分析

Surgical treatment of transclavicular and transsternal tumor

目的 探讨跨锁骨和胸骨肿瘤的外科治疗方法。方法 回顾性分析和总结12例超越颈胸解剖分界线的颈根部和胸腔纵隔肿瘤行颈胸联合进路手术治疗的相关问题。结果 本组良性肿瘤7例，经手术治疗后随访1—8年均健在。恶性肿瘤5例，其中4例为术前各种检查未发现原发灶的颈根部转移鳞状细胞癌，行手术和常规放疗后，1例于术后16个月死于原位复发和腋下转移，1例术后失访，另2例分别于术后4年2个月和2年3个月时随访观察无复发。1例颈根部和纵隔甲状腺乳头癌行手术和放疗后3年4个月健在。结论 通过对12例跨锁骨和胸骨肿瘤颈胸联合进路手术治疗方式和结果分析，提高对传统颈根部肿物手术治疗的认识。

Objective To investigate surgical treatment approach of transclavicular and transsternal tumor. Methods Twelve cases of neck-root and mediastinum thoracis tumor subjected to cervicothoracic- combined surgical treatment were retrospectively analyzed and summarized. Results Seven cases of benign tumor survived 1-8 years after surgery. The other 5 patients were malignant tumor. Among 4 cases of matastatic squamous cell carcinoma without definite origin at neck-root site who underwent operation and routine radiotherapy, one case died of orthotopic relapse and armpit metastasis at the 16th months postoperatively ; one case was lost of follow-up after surgery; another two cases showed no relapse after follow-up of 50 months and 27 months, respectively. In addition, one case of thyroid papillary carcinoma located at neck-root and mediastinum remained alive for 40 months after operation combined with radiotherapy and chemotherapy. Conclusions The evaluation of twelve cases of transclavicular and transsternal tumor with adoption of cervicothoracic-combined surgical approach improves and develops traditional knowledge of surgical therapy of neck-root tumors.