儿童原发性胸部巨大肿瘤的外科处理

Surgical therapy for children with huge thoracic tumors.

目的 总结儿童原发性胸部巨大肿瘤的治疗经验,探讨更有效的外科治疗方式.方法 对于占据整个胸腔的胸内肿瘤采取胸部正中切口,处理肺门或分离肿瘤;而其他肺肿瘤及后纵隔肿瘤则采取常规后外侧切口行肿瘤根治术.对于前纵隔肿瘤酌情采取胸部正中切口或前外侧切口,锐性加钝性法分离,直至完整切除肿瘤为止.结果 5例术前诊断为肺肿瘤的患儿,2例行左全肺切除,1例行右全肺切除,1例行右中下肺叶切除,病理学诊断均为胸膜肺母细胞瘤;另1例行胸壁肿块大块切除术,免疫组化检查结果显示为＂左胸壁肋骨Ewing肉瘤＂;1例术前诊断为胸腔内巨大肿块患儿行肿块切除后病理报告为软骨肉瘤;4例前纵隔肿瘤中,2例为梭形细胞瘤,另2例来源于胸腺,分别为胸腺瘤和恶性神经鞘瘤,肿瘤均被完整切除;4例后纵隔肿瘤均作肿块切除,病理检查报告均为神经母细胞瘤.结论 手术指征、手术径路的把握及术者的经验直接决定胸部巨大肿瘤患儿的治疗效果.

Objective To explore modalitg of surgical treatment meanwhile conclude therapeutic experiences in children with huge thoracic tumors. Methods The median chest incision was employed for the tumors occupied whole thoracic cavity. It is easy to approach the hilum of lung or separat the tumor. Other lung and posterior mediastinum tumors are dealt with posteriolateral incision.The median chest and anteriolateral incision were the choice for the tumor located in anterior mediastinum. The complete resections are taken on all patients. Results In 5 children concerned as suffering lung tumor before operations, 2 left pneumonoresection,1 left pneumonoreseetion and 1 fight middle lower pulmonary lobectomy had been taken. All the pathologically revealed pneumoblastoma. One left chest wall rib Ewing＇s sarcoma was proved postoperatively. The tumor was removed by chest wall bulk excision. The patho].ogieally of the huge thoracic tumors occupying more than whole thoracic cavity was chondrosareoma. Among four anterior mediastinum tumors,two of them was spindle cell carcinoma.the other two originated from thoracic gland, calld malignant sehwannoma and Thymoma.Four tumors had been complete removed. The radical resection operations also had been completed in 4 cases of posterior mediastinum tumors children. Pathological reports show all were neuroblastoma. Conclusions The therapeutic resuhs of children with huge thoracic tumors are directly determined by the control of operative indications and surgical approaches. Operator experiences take part in important role either.