纵隔前肠囊肿的诊断及外科治疗(附51例报告)

Diagnosis and surgical treatment of mediastinal foregut cysts

目的总结纵隔前肠囊肿的临床特点及外科治疗方法。方法回顾性分析经手术病理证实的51例纵隔前肠囊肿的病例资料。结果51例患者中有24例(47.1%)无临床症状。MRI对本病的诊断正确率(16/21,76.2%)高于CT(14/41,34.1%)。囊肿位于前上纵隔5例,中纵隔18例,后纵隔28例。完整切除35例,大部切除16例。病理证实支气管源性囊肿42例,食管囊肿7例,胃肠源性囊肿2例。结论纵隔前肠囊肿术前诊断困难。应积极手术治疗,胸腔镜及胸腔镜辅助小切口是优先选择的手术方式。

Objective Foregut cyst of the mediastinum is an uncommon but important mediastinal disease, representing 40% to 50% of all the mediastinal cysts. The purpose of present study was to summarize the clinical feature and surgical treatment of mediastinal foregut cysts in patients admitted to the authors＇ hospital, and to emphasize the important role of video-assisted thoracic surgery （VATS） played in the treatment of mediastinal foregut cysts. Methods Data of 51 cases of mediastinal foregut cysts confirmed by pathological examination from 1993 to 2006 were retrospectively reviewed. Results 29 male and 22 female patients were involved in the present study. A mong all the cases, 24 （47%） manifested no conspicuous symptom, and the remainders showed various symptoms such as chest pain, dyspnea, cough etc. The findings of magnetic resonance imaging （MRI） were more helpful than that of CT in diagnosis. In the present seties, 5 cysts were located in the antero-supetior mediastinum, 18 in the middle mediastinum and 28 in the posterior mediastinum. All pa tients underwent operation, including 15 minimal invasive surgeries such as VATS. 35 cysts were excised completely and 16 cysts were resected partially. Pathological examination confirmed that, there were 42 bronchogenic cysts, 7 esophageal cysts and 2 gastro-enterogenous cysts. There was no postoperative death or major complications, but minor complications occurred in 3 patients. During an average of 26 months of follow-up （ranged 2 to 56 months）, no recurrence or malignant degeneration was found. Conclusion Mediastinal foregut cysts are rarely diagnosed definitely before operation, and it should be surgically treated because its pathology can only be established after surgi cal extirpation. Video-assisted thoracoscopic surgery is the first choice for the treatment of mediastinal foregut situated, especially for those situated in the middle and posterior mediastinum.