胸腺上皮肿瘤的外科治疗-204例临床病理分析  

Surgical treatment of thymic epithelial tumor: a retrospective review of 204 cases.

作　　者：方文涛[1] 陈文虎[1] 陈岗[1] 何卫中[1] 蒋勇[1] 

机构地区：[1]上海市胸科医院胸外科

出　　处：《肿瘤》2005年第4期377-380,共4页Tumor

基　　金：卫生部吴阶平基金资助(编号:03-2A)

摘　　要：目的总结对胸腺上皮肿瘤(TET)的外科治疗结果以改进现有的治疗方法。方法回顾对204例TET的外科治疗,方法为手术探查切除结合术后辅助治疗。根据WHO胸腺上皮肿瘤组织分型和改良Masaoka分期进行疗效分析。结果全组外科整体切除180例占88.2%(其中根治切除139例占68.1%,大体切除41例占20.1%),部分切除17例占8.3%,单纯活检7例占3.4%;MasaokaⅠ/Ⅱ期肿瘤的外科整体切除率显著高于Ⅲ/Ⅳ期肿瘤(100%和75%,P<0.001),其根治性切除率则更明显地高于后者(94.5N和37.2%,P<0.001)。外科整体切除病例的术中出血量显著少于部分切除或单纯活检病例(524.7ml和1955.4ml,P<0.001)。24例(11.8%)患者术后发生严重并发症29人次,其中肌无力危象11人次,合并重症肌无力、部分切除或单纯活检、Ⅲ/Ⅳ期肿瘤、年龄<45岁为术后发生严重并发症的独立预测因素。术后死亡15例(7.4%),其中6例死于肌无力危象。部分切除或单纯活检以及合并重症肌无力为手术死亡的独立预测因素。术前行激素化疗的术后肌无力危象的发生率及其死亡率均显著降低。WHO组织分型A/AB/B1型TET中Ⅰ/Ⅱ期肿瘤明显多于B2/B3/C型(87.6%和26.4%,P<0.001);其外科整体切除率显著高于B2/B3/C型(98.9%和78.3%,P<0.001)。全组术后5年和10年生存率为63.2%和50.4%。WHO组织分型B2/B3/C型、MasaokaⅢ/Ⅳ期肿瘤及部分切除或单纯活检是预后不良的独立预测因素。结论根治性切除仍然是治癒TET的主要手段,术前激素化治疗有利于降低重症肌无力患者的手术风险;TET的治疗原则应以WHO组织分型和改良Masaoka分期为依据,Ⅰ/Ⅱ期、A-B1型TET切除率高、手术安全、远期预后好,手术治疗应列为首选,术后放疗并无必要;Ⅲ期以上、B2-C型TET切除率低、手术困难且风险较大,传统的“手术探查切除+术后辅助治疗”策略效果不理想,应通过诱导治疗提高切除率以改善疗效。Objective To evaluate the results of surgical treatment of thymic epithelial tumors （TET）. Methods Two hundred and four cases of surgically treated TET were retrospectively reviewed according to the current World Health Organization （WHO） criteria for TET classification and modified Masaoka staging system. Results One hundred eighty cases （88.2%） underwent complete resection, including 139 cases （68. 1%） of radical resection and 41 cases （20. 1%） of nearly complete resection. The rest of the patients received either partial resection of 17 cases （8.3%） or biopsy only of 7 cases （3.4%）. The complete resection rate （100% vs. 75%, P〈0. 001）, especially the radical resection rate （94.5% vs. 37. 2%, P〈0. 001）, of Masaoka stage Ⅰ/Ⅱ tumors were significantly higher than that of stage Ⅲ/ Ⅳ tumors. Intra-operative blood loss was significantly less in patients receiving complete resection than those receiving partial resection or biopsy alone （524.7ml vs. 1955.4ml, P〈0. 001）. Twenty four patients （11.8 %） experienced 29 events of serious complications after surgery, among which there were 11 events of myasthenia gravis crisis. Myasthenia gravis, partial resection or biopsy alone, Masaoka stage Ⅲ/Ⅳ, and age〈45 years were identified as independent risk factors for postoperative complications. Fifteen patients （7. 4%） died after operation during hospital stay, among them 6 patients died from myasthenia crisis. Partial resection or biopsy alone and myasthenia gravis were identified as independent risk factors for postoperative mortality. There were significantly more stage Ⅰ/Ⅱ cases in WHO A/AB/B1 tumors than in B2/B3/C tumors （87.6% vs. 26.4% ,P〈0. 001）, and their complete resection rate significantly high- er than the later group （98.9% vs. 78.3% ,P〈0. 001）. The 5- and 10-year survival rates of total patients were 63.2% and 50.4% separately. WHO classification, Masaoka staging and complete resection were identified as independent prognostic f

关 键 词：胸腺肿瘤/外科学 综合疗法 肿瘤分期 预后 

分 类 号：R736.3[医药卫生—肿瘤] R730.56[医药卫生—临床医学]