小儿纵隔肿瘤的诊断与外科治疗

Diagnosis and surgical therapy for children mediastinal mass

目的总结小儿纵隔肿瘤的临床特征,探讨外科诊治效果。方法选择2009年3月～2012年9月上海市儿童医院手术治疗及病理诊断的小儿纵隔肿瘤43例,分析其病理学类型、发病部位、诊疗方法、临床表现、影像学特点和预后转归情况。结果 43例患儿中恶性肿瘤19例(44.2%),良性肿瘤24例(55.8%)。以节细胞神经肿瘤最多9例(20.9%),其次为成熟畸胎瘤5例(11.6%)和神经母细胞瘤4例(9.3%);以后纵隔为最多15例(34.9%),其次为前纵隔12例(27.9%)和上纵隔11例(25.6%),中纵隔5例(11.5%)最少。完整切除肿瘤22例(51.1%),未完整切除肿瘤20例(46.5%),行活检术1例(2.3%)。临床首发症状为咳嗽8例(18.6%),发热8例(18.6%),胸痛、胸闷8例(18.6%),无临床症状9例(20.9%),外院术后复发2例(4.7%),其他症状8例(18.6%)。胸部X平片可以初步确定肿瘤的部位、形状和大小,胸部CT对本病具有准确的定位和一定的定性作用。术后随访2个月～3.5年,24例良性肿瘤术后恢复较好,1例淋巴管瘤复发。15例恶性肿瘤转入血液科化疗,病情控制较好;1例放弃治疗,出院3个月后死亡;2例放弃化疗后失访。结论小儿纵隔肿瘤临床可无特异性症状,胸部X片及CT检查是诊断的主要依据,确诊依赖病理诊断。外科手术为主要治疗方法,术前应评估患儿临床症状、肿瘤形状、大小、部位及全身情况,制定相应手术方案。

Objective To sum up the clinical features of children mediastinal mass and to discuss the effect of surgical therapy.Methods 43 cases of children mediastinal mass with operative treatment and pathologic diagnosis in Children＇s Hospital of Shanghai City from March 2009 to September 2012 including pathology were selected;pathology type,location of the mass,methods of diagnosis,therapy,clinical manifestation,imaging features and prognosis were retrospectively analyzed.Results Among 43 patients,19 were malignant （44.2％） and 24 were benign （55.8％）.Pathology：9 （20.9％） were ganglion cell never tumor,the next were 5 patients （11.6％） with mature teratoma and 4 patients （9.3％） with neuroblastoma.Location of the mass：15 cases （34.9％） were located at post mediastinum,12 cases （27.9％） were located at anterior mediastinum,11 cases （25.6％） were located at superior mediastinum and 5 cases （11.5％） were located at middle mediastinum.22 patients （51.1％） were treated with complete tumorectomy while 20 cases （46.5％） received incomplete tumorectomy as well as 1 patient （2.3％） received biopsy.First clinical manifestation：8 cases （18.6％） were coughing,8 cases （18.6％） were fever,8 cases （18.6％） were chest pain or distress,9 cases （20.9％） were without any manifestation,2 cases （4.7％） were recurrence after surgery in other hospitals and 8 cases （18.6％） were with other manifestations.The location,shape and size of the tumor could be determined by chest X ray primarily.Chest CT could be used for localization and qualitation.These patients were underwent after surgery for 2 months to 3.5 years.24 patients of benign tumor were found with good outcome after surgery.1 patient of angiolymphoma was found relapsed.15 malignant patients were transferred to department of hematology and received chemo therapy.1 patient gave up treatment and died 3 months after discharging.2 patients gave up chemo therapy and were loss of follow-up.Conclusion There can be no specific clinical manifestation for children mediastinal mass.Chest X ray and CT are the primary methods of diagnosis.Final diagnosis relies on pathology.The main treatment is surgical therapy.It is right to assess the clinical manifestation,shape,size and the location of the tumor,and the condition of the patients before surgery.