经改良的颈胸前入路治疗肺上沟瘤

Treatment of superior sulcus tumors using the improved antero-cervical parasternal approach

目的探讨经改良的颈胸前入路治疗肺上沟瘤的临床经验。方法回顾性分析2005年7月至2010年5月收治的3例肺上沟瘤患者的临床资料，3例患者均经改良的颈胸前入路切口，将第1～3肋骨全部切除，切除1／5椎体1例，第1胸椎横突切除I例，第1、2胸椎横突切除1例，胸1神经根及星状神经节切除1例。结果3例患者术后均恢复顺利，除1例患者术后出现继发性Homer综合征外，无严重并发症发生。3例患者于术后换药时，均见有轻度反常呼吸，但无呼吸困难，耐受良好，继续胸壁加压包扎14d后等待纵隔固定，反常呼吸消失。术后病理诊断：鳞癌2例，腺鳞癌1例，均未见纵隔淋巴结转移，肿瘤切缘阴性。分期：T3N0M02例，T4N0M01例。3例患者术后均行4个周期化疗（NP方案），未行放疗。3例患者术后分别随访53、37、13个月，均存活，肿瘤无局部复发，患者生活质量良好。结论经改良的颈胸前入路能完整切除肺上沟瘤，对侵及胸廓人口处的结构处理方便、安全，是值得推广的手术方法。

Objective To investigate the experience of resection of superior sulcus tumors using the improved antero-cervieal parasternal approach. Methods The clinical data of 3 patients with superior sulcus tumor from July 2005 to May 2010 were analyzed retrospectively. Three patients with superior sulcus tumor underwent en bloc resection using the improved antero-cervical parasternal approach. The 1 st to 3rd rib were excised, 1 case with 1/5 centrum vertebra excision, 1 case with the 1st transverse process of thoracic vertebra excision, 1 case with the 1st and 2nd transverse process of thoracic vertebra excision, 1 ease with T1 nerve root and sellate ganglion excision. Results All the patients recovered well after operation. There was no serious complication except for 1 ease with secondary Homer syndrome. The mild paradoxicalbreathing was found in 3 cases postoperative dressing change, but they had no dyspnea and tolerance well. The paradoxical breathing was disappeared when the mediastinum was fixed after 14 d thoracic wall pressure dressing. The pathological diagnosis after operation： 2 cases with squamous-celled carcinoma, 1 case with adenosquamous carcinoma, there was no mediastinal lymph node metastasis, cutting edge was negative. Stage： 2 cases with T3NoM0,1 case with T4NoM0. Three cases were treated with chemotherapy （NP plan） for 4 cycles after operation without radiotherapy. Three cases were followed up for 53, 37, 13 months after operation, they were all survival without recurrence and good quality life. Conclusions For the treatment of especially anterior and middle seated superior sulcus tumors, improved antero-cervical parasternal approach provides a safe and effective exposure. The improved antero-cervical parasternal approach is worthy of promotion.