完整性切除治疗巨大胸膜孤立性纤维肿瘤(附5例报告)

En bloc resection of giant solitary fibrous tumor of pleura:A report of 5 cases

目的：探讨一种安全、方便地将巨大胸膜孤立性纤维肿瘤（SFTP）完整切除的手术方式。方法：回顾性分析5例肿瘤直径〉10cm的SFTP患者的临床资料。术前应用增强CT明确肿瘤血供,术中均先采用胸腔镜探查明确肿瘤位置、直径及范围,分离与重要脏器相关的黏连,将肿瘤完整切除。其中1例患者术前行滋养动脉栓塞术。记录患者的手术方式、肿物直径大小、手术耗时、出血量、术后置管时间、切缘是否有残留和有无术后并发症等。结果：5例患者的肿瘤均完整切除,切缘均为阴性。术中平均出血量210mL,手术平均耗时112 min,术后平均置管时间3.8d,无围手术期死亡。术后随访6个月-3年,未见肿瘤复发。结论：对于SFTP患者,术前应行增强CT扫描判断肿瘤血供及其与周围脏器的关系,必要时行滋养动脉栓塞;开胸术中辅以胸腔镜是一种较为安全、便捷和可行的方式。

Objective： To investigate a safe and convenient way to perform an en bloc resection of giant solitary fibrous tumor of pleura （SFTP）. Methods： The clinical data of 5 patients with giant SFTP （the diameter 〉10 cm） were collected. Enhanced CT method was used to search the nutrient artery of tumor. Thoracoscope was used to select the location and diameter of the tumor and to assist the separation from the important organ and exposure the operation field, so as to resect the tumor completely. The operation method, diameter of the tumor, operation time, blood loss, drainage time, ineisal margin and postoperative complications were recorded. Results： The tumor of 5 patients were all removed. The mean operation time was 112 min. The blood lose during the operation was 210 mL. The mean drainage time was 3.8 d. There were no perioperative death. There was no tumor recurrence found in the 6--36 months follow up. Conclusion： For the SFTP patients, an enhanced CT and artery embolization preoperatively should be perfomed to judge the blood supplyment of tumor and its relationship with surrounding organs. Thoraeotomy assisted by thoracoscope may offer a safe and feasible method to accomplish an enblocresection.