胸内巨淋巴结增生症外科诊治12例临床分析

Clinical analysis on surgical management of intrathoracic Castleman＇s disease： a report of 12 cases

目的提高对胸内巨淋巴结增生症的认识，探讨其诊断方法和外科治疗效果。方法分析经过病理证实的12例胸内巨淋巴结增生症患者的临床资料。全组均行手术治疗。结果术后住院时间3～9天，平均（6．4±1．9）天。术中出血100～2500ml，平均（1108±696）ml。无手术相关死亡。术后发生饮水呛咳1例，随访8—87个月，所有病例术后均生存，无复发病例。结论胸内巨淋巴结增生症发病率较低，患者缺少特异的症状和体征，没有特异的诊断手段，术前诊断困难。胸内巨淋巴结增生症单中心型可行外科手术治愈，个别可以经胸腔镜手术切除；胸内巨淋巴结增生症多中心型多无法通过手术治愈，应辅助其他综合治疗手段。

Objective To improve the understanding of intrathoracic Castleman＇s disease and to explore the diagnostic method as well as surgical management of this disease. Methods The clinical data of 12 patients with intrathoracic Castle- man＇s disease confirmed by pathology preoperatively who underwent surgical treatment was retrospectively analyzed. Results The postoperative hospital stay was 3 -9 days, with a mean of （6.4 _＋ 1.9） days. The operative blood loss was 100 - 2500 ml, with a mean of （1108 -696） ml. Tthe postoperative complications were minimal with only 1 case of cough when drinking water and all the patients survived after surgical resection without recurrence during the followed up of 8 - 87 months. Conclusion The Castleman＇s disease is characterized with low incidence and non - specific manifestation without effective preoperative diagnosis. Besides, the localized type of intrathoraeie Castleman＇s disease is curable through surgical resection including video - assisted thoraeoscopic surgery （ VATS）, whereas the multieentric type cannot be cured simply through surgery, which require multidiseiplinary therapy.