原发颈胸交界处非肺源性肿瘤的外科治疗  

Primary nonbronchogenic tumors of the cervicothoracic junction : results of resection by the hemi-clamshell approach

作　　者：王祖义[1] 刘学刚[1] 唐震[1] 史向前[1] 刘以尧[1] 李小军[1] 

机构地区：[1]蚌埠医学院附属医院胸心外科,安徽蚌埠233004

出　　处：《解剖与临床》2005年第3期213-215,共3页Anatomy and Clinics

摘　　要：目的:总结采用半蛤壳状切口对原发颈胸交界处非肺源性肿瘤进行外科治疗的临床疗效.方法:1999年5月至2004年12月我们应用半蛤壳状切口对8例颈胸交界处肿瘤进行了手术治疗,资料收集包括肿瘤的病理类型与范围、切除的方式、手术并发症及预后.结果:7例病人肿瘤完整切除,切缘阴性,其中5例成功地完成了肿瘤及其受累组织的En bloc切除,切除的受累组织包括肺(n＝3)、心包(n＝2) 、上腔静脉(n＝1) 、迷走神经(n＝1)、喉返神经(n＝1)、壁层胸膜与星壮神经节(n＝1).2例病人出现轻微的并发症,无手术死亡.随访期2个月～5年9个月,2例病人死于肿瘤复发.结论:颈胸交接处肿瘤的病理类型复杂,合理的术前评估与肿瘤分类有利于术式的选择.采用半蛤壳状切口有利于肿瘤的暴露与切除,并发症及死亡率低,可获得满意的长期疗效.Objective： To summarize the experience of using the hemi - clamshell approach for resection of the primary nonbronchogenic tumors of the cervicothoracic junction.Methods： Between May 1999 and December 2004, we undertook 8 operations by means of hemi - clamshell approach. The data collected included tumor type and involvement, type of resection, complications and prognosis. Results： Complete resection of the tumor was performed in 7 of the 8 cases with negative margins. En bloc resection of the tumor and invaded structures were successful. Invaded structures resented included lung （ n = 3 ）, pericardia （ n = 2 ）, superior vena cava （ n = 1 ）, phrenic nerve （ n = 1 ）, recurrent laryngeal nerve （ n = 2 ）, parietal pleura and stellate ganglion （ n = 1 ）. Two mild complications occurred. There were no intraoperative or postoperative deaths. The follow - up period ranged from 2 months to 5 years and 9 months. Two patients died as a result of their tumors. Conclusion： Tumors of the cervicothoracic junction are represented with a variety of historical types. Detailed preoperative evaluation and reasonable classification of the tumor are helpful to the choice of surgical approach. The hemi - clamshell approach is beneficial to the exposure and resection of the tumors with a low complication rate and zero mortality rate. Long - term survival is obtainable.

关 键 词：肿瘤 颈胸交界处 半蛤壳状切口 胸外科手术 

分 类 号：R730.5[医药卫生—肿瘤]