颈胸联合部肿瘤的外科治疗

The surgical treatment for the tumor of neck-thoracic junctional region

目的 探讨颈胸联合部肿瘤外科治疗的手术方法及要点。方法 14例颈胸联合部肿瘤施行手术。经颈正中加胸骨正中切口 4例 ,颈正中、胸骨次全劈开、前胸外侧联合切口 (半蛤壳切口 ) 10例。肿瘤完全切除 11例 ,姑息性减状切除 3例。结果 全组无手术死亡 ,1例原始神经外胚层瘤术后 18个月、2 6个月分别转移至右肺尖、心包 ,已行二次、三次手术。随访 4～ 72月 ,晚期死亡 3例 ,死于肿瘤复发。结论 颈胸联合部肿瘤组织来源呈多样化 ,以神经源性肿瘤多见 ;一经确诊应争取手术治疗 ;半蛤壳切口创伤稍大 ,但术野清晰 ,利于防止副损伤 ;术中注意气管的悬吊复位 ,利于保持气管通畅。

Objective To study the operative method and key points of surgical treatment for the tumor of neck-thoracic junctional region.Methods Fourteen cases were performed tumor resection.All cases were operated in general anesthesia,combined median neck and median sternotomy 4,combined median neck,partial division of stenum and anterior lateral incision (hemi-shell incision)10 cases.Currstive resrction was in 11 cases,and palliative resectian was 3.Results There are no operative mortality in this group.One case was reoperated for recurrenace postoperatively.3 cases died of matastasis in follow up period.Conclusions For impression of trachea,esophagus and vessels,resection should be done after diagnosis,Hemi-shell incision has some advantages such as good vision and preventing accidental injury.It is necessary to prolong ventilation postoperatively,which is useful to maintain trachea into position and respiratory tract clear.