巨大纵隔肿瘤的诊断和外科治疗

Diagnosis and surgical treatment for giant tumor of mediastinum

目的 探讨巨大纵隔肿瘤的诊断和外科治疗经验。方法 回顾分析 1996年 1月～ 2 0 0 2年 12月 ,38例巨大纵隔肿瘤患者的临床资料 ,其中男性 2 7例 ,女性 11例 ,良性肿瘤 32例 ,恶性肿瘤 6例 ,肿瘤平均直径 10cm以上。 1例在股静脉 -股动脉体外循环下手术 ,1例术后出现气管软化 ,放置气管内支架。结果 无围手术期死亡 ,随访 3个月～ 3年 ,5例失访 ,1例术后 1年因恶性淋巴瘤肝转移死亡 ,其他均恢复良好。结论 术前应常规行CT检查 ,选择合适的麻醉及手术径路 ,术中可视情况分块切除或整块切除 。

Objective To review the experience of diagnosis and surgical treatment for giant tumor of mediastinum. Methods Thirty eight patients with giant tumor of mediastinum were treated surgically from Jan. 1996 to Dec. 2002, including 27 men and 11 women. 32 cases were benign tumors, and 6 cases were malignant tumors. The average diameter of the tumors was more than 10 cm. Femorofemoral cardiopulmonary bypass was used in one patient, and metallic stent was inserted in one patient against the stenosis of trachea. Results There was no perioperative death occurred. During the period of 3 months to 3 years after operation, five cases lost in follow up, one case died from metastasis of malignant lymphademoma, others recovered nicely. Conclusion The routine preoperative CT examination, proper anesthesia and surgical route were equally important. Postoperative management includes prevention of the occurrence of sunken trachea and dilatant pneumoedema.