小儿颈纵隔淋巴管瘤的外科治疗  

Surgical Treatment of Cervicomediastinal Lymphangiomas in Children

作　　者：张兴华[1] 皮名安[1] 龚立[1] 王涛[1] 谢艳丽[1] 

机构地区：[1]武汉市儿童医院心胸外科,武汉430016

出　　处：《实用儿科临床杂志》2012年第21期1686-1687,1696,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的总结小儿颈纵隔淋巴管瘤的特点,探讨其手术方法。方法回顾性分析2005年8月-2011年7月本院收治经术后病理证实的颈纵隔淋巴管瘤患儿31例,男10例,女21例;年龄1个月～4岁,平均年龄11.0个月,肿瘤位于右侧11例,左侧20例。结果 7例经颈部锁骨上横切口手术;24例纵隔病变为主者经后外侧切口常规开胸手术。完整切除14例,其他病例行大部切除,囊壁破坏或囊肿揭顶引流,残留囊壁碘酊烧灼。术中损伤无名静脉1例,术后并乳糜胸5例、喉返神经损伤3例、膈神经损伤2例、复发3例,无死亡病例。结论颈纵隔淋巴管瘤一经诊断应立即手术,切口的选择很重要,应根据CT及MRI结果慎重选择,单一切口多可完成手术。术中不宜强求完整切除,残留囊腔敞向胸膜腔可减少术后复发。Objective To summary the characteristics and surgical methods of lymphangiomas located at cervicomediastinum. Methods The clinical data of 31 cases of cervicomediastinal lymphangiomas were retrospectively reviewed.There were 10 boys and 21 girls,with age range from 1 month to 4 years old and the mean age was 11.0 monthes.There were 11 cases of right cervicomediastinal type and 20 cases of left type.All cases were pathologically diagnosed after operation. Results Among the 31 cases of cervicomediastinal type.Seven cases was performed with resection through supraclavicular transverse incision;lateral thoracotomy was performed with resection of 24 cases of mediastinal lesions mainly.Complete resections were performed in 14 cases and the remaining were subjected to partial resection.And treatment with destruction or cyst drainage,unroofing residual wall iodine burning;carbolic acid for residual lesions,5 cases of postoperative chylothorax,hoarseness of 3 cases,diaphragmatic elevation of 2 cases,intraoperative injury innominate vein in 1 case,recurrence of 3 cases,no deaths.Du-ring operation innominate vein was injured in 1 case,and postoperative recurrence occurred in 3 cases.Postoperative complications include 5 cases of postoperative chylothorax,3 cases of recurrent laryngeal nerve injury,phrenic nerve injury in 2 cases,there were no dead cases. Conclusions The operation should be performed once the diagnosis of cervicomediatinal tumors is made.It is important to select a suitable incision,the choice of incision should be carefully chosen according to computerized tomography and magnetic resonance imaging results,a single incision is sufficient.It is suggested that letting the residual sack be uncovered towards to pleural cavity help to reduce the recurrence.

关 键 词：颈纵隔淋巴管瘤 外科治疗 儿童 

分 类 号：R733.4[医药卫生—肿瘤]