18例纵隔血管瘤的外科治疗

Surgical management of mediastinal hemangioma： a report of 18 cases

目的总结纵隔血管瘤的外科诊治经验。方法收集1994年1月至2017年8月手术治疗18例纵隔血管瘤患者的临床资料，男、女各9例，平均年龄（50.9±14.0）岁。体检发现11例，余7例因出现相关症状就诊。发病位于前纵隔3例，中纵隔1例，后纵隔14例。所有患者均行胸部CT或胸部增强CT检查，16例见纵隔部位边界清楚的软组织密度肿块，7例肿块呈不均匀强化，2例肿块内见数个点状钙化。术前诊断均未能明确，怀疑血管源性肿瘤2例，余16例怀疑胸腺来源肿瘤、神经源性肿瘤或恶性肿瘤等。8例行胸腔镜辅助下纵隔肿瘤切除术，其中3例因高出血风险中转开胸；余10例均行开胸手术。结果全组手术顺利，无围手术期死亡，无术后主要并发症发生。1例因肿瘤出血风险极大仅行活检，余17例均完整切除肿瘤。平均手术时间（105.0±49.6）min，平均失血量（111.7±138.9）ml，术后住院（4.7±3.5）天。随访1-18个月，中位时间9.6个月，完全切除肿瘤者均无复发，活检病例病灶稳定无进展。结论纵隔血管瘤临床罕见，无特异性的临床表现，胸部CT检查示点状钙化或静脉石可提示肿块的血管成分，术前确诊较困难，治疗以手术切除为主，预后良好。

ObjectiveTo summarize our experience in surgical intervention of patients with mediastinal hemangioma.MethodsFrom January 1994 to August 2017, 18 patients underwent surgical treatment were diagnosed with mediastinal hemangioma in our department. There were 9 females and 9 males, with the average age of（50.9±14.0） years. Seven patients were seen with signs and symptoms related to the tumor, and the other 11 patients had no symptom. Three cases were located in the anterior mediastinum, 1 case in the middle mediastinum and 14 cases in the posterior mediastinum. All of the cases experienced chest computed tomography（unenhanced or contrast-enhanced CT scan）. Most mediastinal hemangiomas manifested as well-marginated masses at CT. Seven hemangiomas showed heterogeneous enhancement at contrast-enhanced CT. Calcifications were demonstrated in 2 patients. Preoperative diagnosis was not confirmed in all patients. Two cases were suspected to be hemangioma preoperatively, other cases were suspected to be thymoma, neurofibroma or malignancy. Eight cases were treated by video-assisted thoracic surgery approach, 3 of those converted to thoracotomy due to high risk of hemorrhage. Ten cases experienced traditional thoracotomy.ResultsSeventeen patients had total excision, but one experienced biopsy because of hemorrhage. There were no operative death and major complications. The average operation time was（105.0±49.6）minutes, and the average blood loss was（111.7±138.9）ml. The postoperative hospital stay was（4.7±3.5）days on average. Follow-up time ranged from 1 to 18 months（median, 9.6 months）. No recurrence was found in the patients with total excision at the time of follow-up. The patient undergoing biopsy showed no progression of the disease for 12 months.ConclusionMediastinal hemangiomas were rare tumors, without relatively specific clinical manifestation. Calcification and phleboliths on CT scan were helpful in suggesting the vascular nature of the mass. Preoperative diagnosis of mediastinal hemangioma was usually very difficult. Mediastinal hemangiomas were mainly treated by surgical approach and had good prognosis.