颈部和胸腔以及腋窝交汇区域肿瘤的手术治疗

Surgical management of tumor in the conjunctive area among neck,thorax and axilla

目的探讨颈部、胸腔和腋窝交汇处良性肿瘤的手术方法及其疗效。方法回顾分析1999年10月至2006年3月期间11例发生于颈部、胸腔和腋窝交汇区域良性肿瘤患者的诊治过程,其中神经鞘膜瘤5例,神经纤维瘤3例,软骨瘤2例,脊膜瘤1例。CT 检查示所有患者的肿瘤均不同程度侵犯颈部、胸腔和腋窝,其中4例患者伴椎体破坏,1例伴脊髓压迫。离断胸骨柄,保留胸锁关节完整,将锁骨移位后分别分离解剖颈部、腋窝及上纵隔血管,直视下切除肿瘤。其中1例行锁骨下静脉重建。结果术中椎动脉起始部裂隙状损伤2例,在阻断锁骨下动脉及椎动脉远心端后成功缝合。所有患者术后上肢功能均恢复良好,无永久性颅神经麻痹,无乳糜瘘或术后感染。随诊3个月至3年5个月,CT 检查未见肿瘤残存或复发。结论采用锁骨移位方法可在直视下彻底切除颈部、胸腔和腋窝交汇区域良性肿瘤,并较好地保护该区域重要血管神经。

Objective To study the surgical management of tumors in the conjunctive area among the neck, thorax and axilla and its efficacy. Methods From Oct. 1999 to March 2006, eleven cases with benign tumors in the area between the neck, thorax and axilla were collected and analysed. Among them, five neurilemmoma, three neurofibroma, two chondroma and one meningioma, respectively. CT scans showed that the neck, thorax and axilla were affected simultaneously more or less. In this group, direct invasion to the vertebra was found in 4 cases, and spinal compression in one patient. After the disarticulation and displacement of the clavicle, the tumor was removed with the structures of importance in the neck, thorax and axilla under direct views. A bypass was constructed between the axillary vein and the medial end of the subclavian vein. Results All these tumors were completely removed, injury of vertebral artery was encounted in two cases, and immediate repair was successfully carried out. No other serious complications were found in this group. During the follow-up period from 3 months to 3 years and 5 months, local recurrence was found in no patient. Conclusions Benign tumors in the area between neck, thorax and axilla could be successfully dissected and removed with displacement of the medial portion of the clavicle.