外科治疗36例侵袭性胸腺瘤伴血管置换的临床经验

A retrospective study of 36 cases with reconstruction of mediastinal vessels for invasive thymoma

目的探讨累及纵隔大血管侵袭性胸腺瘤的外科治疗方式及其术后疗效。方法 2007年4月—2017年4月,上海市胸科医院共收治累及纵隔大血管侵袭性胸腺瘤患者36例,对患者的临床资料、手术方式、辅助放化疗以及随访情况进行分析。结果全组患者手术顺利,无术中或院内死亡病例,29例(81%)患者的肿瘤被完全切除。14例患者行单纯上腔静脉置换;10例患者行左无名静脉—右心耳搭桥;3例患者行右无名静脉—右心耳搭桥;2例患者行左无名静脉—右心耳搭桥+上腔静脉切除,其余患者均行复杂血管置换手术(>1根血管桥)。共10例(27.8%)患者术后发生并发症,其中肺部感染5例,电解质紊乱2例,乳糜胸、肺不张、活动性出血二次手术开胸探查各1例。其余患者中,13例复发患者中10例在随访过程中死亡。患者3年和5年总生存率分别为79.1%和58.8%。与姑息切除组(n=7)相比,完全切除组(n=29)患者的预后更好,两组比较差异有统计学意义(Log-rank P=0.048)。结论侵袭性胸腺瘤累及纵隔大血管后行人工血管置换是可行的手术方式。完全切除肿瘤及其累及组织对提高手术疗效、改善患者预后至关重要。

ObjectiveTo investigate the surgical treatment of invasive thymoma invading adjacent great vessels.MethodsA retrospective study on36patients with invasive thymoma invading adjacent great vessels was performed.The corresponding data including clinical presentation,operation procedure,adjuvant radio chemotherapy and follow up were reviewed.ResultsAll the patients were successfully operated without any intraoperative or hospital deaths.The tumors of29patients(81%)were completely resected.14patients underwent simple superior vena cava(SVC)reconstruction;10patients underwent left brachiocephalic vein(BCV) right atrial appendage(RAA)reconstruction;3patients underwent right BCV RAA reconstruction;2patients underwent left BCV RAA reconstruction along with SVC resection;and other patients underwent complex vessel reconstruction(more than1vascular bridge).Ten patients(27.8%)had postoperative complications,including5cases of pulmonary infection,Two cases of electrolyte disturbance,1case of chylothorax,1case of atelectasis,and1case of haemothorax.Two patients died due to acute respiratory distress syndrome within90days after the surgery.Of the remaining patients,13cases(36%)experienced a relapse and finally10cases(27.8%)died.Compared to R1resection group,R0resection group had a better prognosis(P=0.048).The3year and5year survival rates were79.1%and58.8%,with median survival time of84months.ConclusionsReconstruction of mediastinal vessels for invasive thymoma is a feasible technology.Radical resection of the tumor with involved adjacent structures is the key to prolong overall survival for patients suffered from invasive thymoma.