胸膜孤立性纤维瘤手术治疗临床分析

A summary of surgical work experiences in treating pleural solitary fibrous tumor

目的总结胸膜孤立性纤维瘤的手术治疗经验,提高对巨大胸膜肿瘤手术治疗方式的认识。方法分析总结23例胸膜孤立性纤维瘤患者的临床资料,其中3例为巨大胸膜肿瘤。1例复发性巨大肿瘤因严重侵犯周围器官,为完整彻底切除肿瘤而采用了正中切口＋侧胸后外侧切口,术中出血量大,约达8000 m L。其余22例均采取肿瘤所在侧胸腔侧胸后外侧切口。结果 23例胸膜肿瘤均予手术完整切除,所有患者均顺利康复出院,平均术后住院时间8.6天。术后随访3个月~3年,均未发现复发及转移。结论胸膜孤立性纤维瘤是一类较罕见的肿瘤,主要通过病理组织学及免疫组化确诊;根治性切除是其首选治疗手段。对巨大胸膜肿瘤手术时需高度关注切口选择、出血量及循环变化,术中及术后需麻醉科、ICU及血库密切配合。

Objective By means of analyzing and summarizing the surgical work experiences available to us so far, our work intended to develop theoretical knowledge for guiding surgical practice in treating pleura1 solitary fibrous tumor. Method The clinical data of 23 cases of pleural solitary fibrous tumor, including 3 cases of giant tumor, were firstly collected for our study. All the patients were pathologically diagnosed as cases of pleural solitary fibrous tumor and subjected to surgical treatment by the Department of Thoracic Surgery of the Second Affiliate Hospital of Zhejiang University during the period from Jan. , 2007 to Jun. , 2013. One case suffered an amount of bleeding of 8000ml as a result of two incisions. The other 22 cases were all treated by lateral thoracic posterior lateral incision on the same side of the tumor. Findings All 23 patients fully recovered from removal of the entire pleural tumor. The average length of hospitalization was 8.6 days. Follow - ups were conducted 3 months to 3 years after the surgeries. No cases of recurrence or metastasis were found. Conclusion Pleural solitary fibrous tumor is an uncommon tumor, which can be diagnosed mainly by pathological and immunohistochemical technologies. Radical operation should be the first option for treatment of this type tumor. As to giant tumor, the selection of the place for incision needs to be scientifically evaluated. Hemorrhage and cyclostationary should be closely attended. Close cooperation with anesthesia, ICU and blood bank in and after surgery should also be established adequately.