小儿纵隔肿瘤的临床特征与外科治疗

The clinical featuves and surgical treatment of pediatric mediastinal tumor.

目的 探讨小儿纵隔肿瘤的临床病理特征,总结外科诊疗方法.方法 回顾性分析本院43例纵隔肿瘤患儿的临床资料,分析其解剖位置、病理学类型、临床表现、诊疗方法及预后情况.结果 43例中,以神经源性肿瘤（15/43,34.9%）最常见,其次为胸腺肿瘤（9/43,20.9%）.呼吸系统症状是最主要的临床表现（17/43,39.5%）,无症状患者亦有较高比例（15/48,34.9%）.36例行全麻下肿块全部或部分切除,3例行开胸活检,4例仅在局麻下行活检术.4例患儿先行局麻下股-股心肺转流准备后再行全身麻醉,其中2例麻醉诱导时发生呼吸循环功能障碍而开启体外循环.1例未行体外转流患儿全麻诱导时突发急性呼吸循环功能衰竭而死亡.结论 小儿纵隔肿瘤可无特异性症状,胸部CT及MRI检查是诊断的主要依据.因儿童独有的生理解剖特性,小儿纵隔肿瘤麻醉风险大,术前应仔细评估患儿临床症状、肿块大小、位置及心肺功能情况,制定完善的手术策略.

Objective To estimate the clinical pathological type of pediatric mediastinal tumor and summarize its surgical treatments. Methods Features of 43 pediatric mediastinal tumor eases were retrospectively analyzed on position of tumor, pathological types,clinical manifestations,diagnosis,therapy and prognosis. Results The most common histological diagnosis was neurogenic mass （15/43,34.9%）,foLlowed by thymoma （9/43,20.9%）. Respiratory symptoms were the most common mode of pediatric mediastinal tumor （17/43,39.5%）,asymptomatic children also constituted high ratio （15/48,34.9%）.Thirty-six of the 43 patients who underwent surgery had complete Or partial excision of the mediasfinal masses under general anesthesia, 3 cases underwent biopsies with open-chest, whereas biopsies with local anesthesia were obtained from the remaining 4 cases. Cardiopulmonary bypass through the femoral vein and a（tery were kept ready before general anesthesia in four children, whereas 2 cases opening it because of acute respiratory circulatory failure underwent anesthesia induction. One case of pediatric mediastinal tumor who was not prepared for cardiopulmonary bypass died of acute respiratory circulatory failure in the induction of anesthesia. Conclusions Mediastinal masses in children are a heterogeneous group of nonspecific symptomatic,CT and MRI are the main diagnostic basis.On account of the anatomical features of chidrcn, anesthetic risk of pediatric mediastinal tumor is very high.We should assess the clinical manifestations, the size and location of tomor and the cardiopulmonary function of children carefully to establish reasonable surgical tactics.