纵隔巨大实质性肿瘤的外科治疗

Surgical treatment for giant solid tumor of the mediastinum

目的 总结纵隔巨大实质性肿瘤的外科治疗经验。方法 回顾分析 2 0例纵隔巨大实质性肿瘤病人的临床资料 ,男 12例 ,女 8例。肿瘤重 110 0～ 480 0g。有 2例气管受压梗阻 ,在股—股转流诱导麻醉下手术。结果 院内死亡 1例 ,治愈 19例。结论 对合并上气道或上腔静脉阻塞的病例 ,先于局麻下建立股—股转流 ,以顺利渡过麻醉诱导期。手术径路要达到充分显露 ,术中可分块切除或控制瘤蒂后整个切除 ,对侵及大血管者同期作血管成形术。术后注意防治复张性肺水肿。

Objective To review the experience of surgical treatment of giant solid tumor of the mediastinum. Methods Twenty patients with giant solid tumor of mediastinum were treated surgically from 1975 to 1997. There were 12 men and 8women with age ranged from 9 to 65 years. The weight of resected tumor was 1100～4800g, average 2200g. Femorofemoral cardiopulmonary bypass was used prior to induction of anesthesia as a precaution against total tracheal occlusion in two cases. Results There was one postoperative death with a mortality of 5%. The cause of death was multi-organ failure. Nineteen patients recovered uneventfully and returned to normal life. Conclusions Diagnosis of GSTM was not difficult. Femorofemoral CPB was used prior to induction of anesthesia for patients with superior airway obstruction and superior vena cava occlusion. When major vessels were involved, vascular reconstruction should be performed. Perioperative management included strict hemostasis, proper chest wall reconstruction and prevention of the rare occurrence of dilatant pneumoedema.