Ⅲ、Ⅳa期侵袭性胸腺瘤的手术、综合治疗及预后分析  

Surgical and adjuvant treatment for malignant thymoma in stage Ⅲ and Ⅳa and their prognosis

作　　者：唐健[1] 于长海[1] 李捷[1] 李少军[1] 

机构地区：[1]解放军总医院第一附属医院胸心外科,北京100048

出　　处：《临床肺科杂志》2012年第7期1285-1287,共3页Journal of Clinical Pulmonary Medicine

摘　　要：目的四年期间以手术为主治疗29例Ⅲ、Ⅳa期恶性胸腺瘤的治疗经验。方法按肿瘤大小及位置分别采用正中劈胸骨切口或后外侧切口施行手术,切除肿瘤全部或大部,术后均行放疗并相应化疗。结果 23例Ⅲ期恶性胸腺瘤患者术中将肿瘤彻底或大部切除,6例Ⅳa期者亦尽量将心包或胸腔内的转移灶清除,难以清除者予以电灼促进坏死。所有患者术后分别接受放疗及化疗,无治疗期间死亡病例。随访1～6年,平均随访34.7个月,Ⅲ期患者的1、3、5年生存率分为100%(23/23)、91.3%(21/23);86.9%(20/23)。Ⅳa期手术组的1、3、5年生存率分为100%(6/6)、66.7%(4/6)、50%(3/6)。结论Ⅳa期并非手术的绝对禁忌证,尽可能以手术方式减低肿瘤负荷再辅以综合治疗可取得较好疗效。Objective To review the experience of surgical and complex treatment for 29 cases with malignant thymoma in 4 years（stageⅢ/Ⅳa）.Methods Medial sternotomy or post-lateral thoracotomy were used according to the size and the position of the tumor,resected the mass completely or majorly,and all patients accepted the complex treatment according to the pathological results.Results 23 patients＇tumors were resected completely or partly,pericardial or pleural metastases of 6 patients in stage Ⅳa were also resected or cauterized.All patients accepted chemotherapy and radiotherapy,no mortality was found during hospitalization,follow up 1~6 years mean 34.7 months.The survival rate of patients in stage Ⅲ in 1,3,5 years was respectively 100%（23/230）,91.3%（21/23） and 86.7%（20/23）,the patients in stage Ⅳa who accepted the operation was respectively 100%（6/6）,66.7%（4/6）,and 50%（3/6）;and statistically significant difference was found between the later two groups（P0.01）.Conclusions Thymoma in stage Ⅲ should be resected radically and the adjuvant therapy also should be given to these patients.Thymoma in stage Ⅳ is not contraindication,majorly resection and proper adjuvant therapy will also get good clinical curative effect.

关 键 词：恶性胸腺肿瘤 手术 综合治疗 预后 

分 类 号：R736.3[医药卫生—肿瘤]