前纵隔肿瘤的外科治疗

Surgical Treatment of the Anterior Mediastinal Tumors

目的 :探讨前纵隔肿瘤外科治疗中的有关技术问题。方法 :1985年～ 2 0 0 0年外科治疗前纵隔肿瘤 10 2例 ,位于前上纵隔 6 7例 ,前下纵隔 35例 ;肿瘤直径大于 10cm者 13例。采用正中切口入路 13例 ,颈领式切口 4例 (1例纵劈胸骨 ) ,前外侧切口 2 1例 (3例加胸骨横断 ) ,余采用标准后外侧切口。结果 :肿瘤全部切除 87例 ,部分切除 11例 ,未切除 4例。联合肺切除 9例 ,部分心包切除 7例。术中损伤血管 7例 ,成功修补损伤 6例 ,1例失败。全组死亡 6例 ,死亡率为 5 .8%。结论 :前纵隔肿瘤的手术切口应根据病变类型、位置和肿瘤的大小而定 ;对巨大肿瘤以后外侧切口显露最佳 ,巨大肿瘤或粘连紧密时可分块切除 ;前上纵隔肿瘤切除时要防止大血管的损伤。

Objective: To explore the surgical treatment of the anterior mediastinal tumors. Methods: 102 cases of the anterior mediastinal tumors were retrospectively reviewed from 1985～2000. Of them, masses located on the anterior superior mediastinum in 67, anterior inferior mediastinum in 35. Diameter of the tumor was greater than 10cm in 13 cases. The operative entrances were applied median sternotomy in 13 cases, neck transverse incision in 4(plus splitting sternum in one), anterolateral thoracotomy in 21(plus sternal intersection in 3), the rests were performed by the posterolateral thoracotomy. Result: Among 102 cases, complete excision was performed in 87, incomplete excision in 11, explorative thorecotomy in 4. Combined with lobecotomy in 9 and partial pericardia excision in 7. Unexpected injury of vessel in 7. Operative mortality was 5.8%. Conclusion: Choice of the operative entrance for anteriormediastinal tumors depend upon the type of disease, location and size. The posterolateral excision would be the best choice for vast masses, which can been resected by pieces. Damage of the great blood vessel should be prevented carefully.