原发性纵隔脂肪肉瘤的外科治疗

Surgical therapy of primary liposarcoma of mediastinum

目的探讨原发性纵隔脂肪肉瘤的临床、病理特征、诊断、外科治疗及预后。方法分析1980至2008年我院手术切除并获病理诊断的13例纵隔脂肪肉瘤的相关临床病理资料,并复习文献。结果13例中男8例,女5例,年龄14～53岁,平均42岁。瘤体直径最大4.5～22 cm,前上纵隔7例,后纵隔6例。主要症状包括胸闷,呼吸困难,咳嗽,胸痛,吞咽困难,发热,咳痰,心悸和颈部肿块等。经包括影像学检查在内的综合检查确诊脂肪肉瘤2例,其余11例误诊。7例完整切除,5例姑息切除,1例放弃手术。结论综合运用影像学检查术前诊断纵隔脂肪肉瘤较困难;积极行手术切除肿瘤是纵隔脂肪肉瘤患者获得长期生存的惟一途径,而肿瘤的大小、对重要血管和邻近脏器的侵犯程度是影响肿瘤能否切除的重要因素。

Objective To explore clinical and pathological characteristics, diagnosis, surgical treatment and prognosis of primary liposarcoma of mediastinum. Methods The data of 13 cases of primary liposarcoma of mediastinum were analyzed retrospectively, and the literatures were reviewed. Results In 13 patients, 8 cases were men and 5 were women, ranging from 14-year-old to 53-year-old （ mean of 42-year-old）. Maximal diameter of tumor was 4.5 - 22 cm. Lesion of 7 patients located in anterior and superior mediastinum, and 6 cases in posterior mediastinum. The symptoms of all patients included chest distress, dyspnea, cough, chest pain, dysphagia, fever, expectortion and palpitation and so on. Conclusion It is difficult to confirm diagnosis preoperatively by imaging detection. Radical resection is the unique method for long survival. The diameter of the tumor and degree of infihration to major vessels and organs is important.