131例纵隔原发性神经源性肿瘤手术治疗的临床经验分析  

Clinical experience of primary neurogenic tumors in mediastinum with surgical treatment in 131 cases

作　　者：方硕[1] 詹成[1] 张毅[1] 姚光宇[1] 谢晓枫[2] 张永星[1] 范虹[1] 

机构地区：[1]复旦大学附属中山医院胸外科,上海20032 [2]复旦大学附属中山医院病理科,上海20032

出　　处：《复旦学报（医学版）》2017年第2期196-201,共6页Fudan University Journal of Medical Sciences

基　　金：国家自然科学基金(81401875)~~

摘　　要：目的分析纵隔原发性神经源性肿瘤行手术治疗患者的临床特征、治疗方法和预后情况。方法回顾性分析复旦大学附属中山医院胸外科2008年1月至2014年12月期间已行手术且病理证实为纵隔原发性神经源性肿瘤共131例患者的临床资料,包括临床特征、影像学表现、手术方式、病理学形态和预后。结果 131例患者中男性78例(59.5%),女性53例(40.5%);有症状者59例(45.0%),无症状者72例(55.0%);肿瘤位于左后纵隔61例,右后纵隔69例,前纵隔1例。电视辅助胸腔镜手术(video-assisted thoracic surgery,VATS)98例(74.8%),VATS辅助胸部小切口手术5例(3.8%),开胸手术28例(21.4%)。除1例恶性神经鞘瘤行姑息性切除外,其他均完整切除,无围手术期死亡。病理类型显示良性神经鞘瘤98例(74.8%),神经节细胞瘤24例(18.3%),恶性神经鞘瘤2例(1.5%),神经纤维瘤2例(1.5%),副神经节瘤2例(1.5%),原始神经外胚层肿瘤(primitive neurotodermal tumour,PNET)2例(1.5%),神经母细胞瘤1例(0.8%)。术后随访12~95个月,平均53个月,1例PNET因肿瘤广泛转移死亡,1例恶鞘姑息切除术后20天死亡,2例因其他原因死亡,其余均无瘤存活至2016年1月。结论纵隔神经源性肿瘤多无特异性临床症状,绝大部分为良性,手术切除预后良好,但恶性肿瘤则预后较差。Objective To analyze the clinical features,methods of treatment and prognosis of primary neurogenic tumors of mediastinum in patients taking surgical intervention. Methods A database was maintained retrospectively of all patients undergoing surgery for tumor and pathologically diagnosed with primary neurogenic tumors of mediastinum,managed in the Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai between Jan., 2008 and Dec., 2014. This work analyzed retrospectively the information about clinical and imaging features, surgical techniques and outcome extracted from medical records. Results Among the 131 cases, 78 cases （59.5%） were males, 53 cases （40.5%） were females; 72 cases were diagnosed incidentally （55.0%）, while the other 59 cases （45.0%） suffered from different symptoms. The posterior mediastinum was the most principal location with 61 cases in the left and 69 cases in the right, and 1 case remained in the anterior mediastinum. Total 98 cases （74.8%） underwent surgeries via video-assisted thoracic surgery （VATS）, 5 cases （3.8%） took VATS surgery with small incision, and 28 cases （21.4%） experienced open thoracotomy, with no mortality during perioperative period. Gross total resection was obtained in 130 patients （99.2%）. The remaining patient underwent a palliative resection for malignant schwannomas. Of the patients,98 cases had benign schwannomas （74.8%）, 24 cases had gangliocytomas （18.3%）, 2 cases had malignant schwannomas （1.5%）, 2 cases had neurofibromas （1.5%）, 2 cases had paragangliomas （1.5%）, 2 cases hadprimitive neurotodermal tumor （PNET） （1.5%） and 1 case had neuroblastomas （0.8%）. All patients were followed up from 12 to 95 months with an average of 53 months. A patient with PNET died of tumor metastasis, a patient with malignant schwannomas died after palliative ectomy, and 2 cases died of other reasons. The rest survived until Jan., 2016 with tumor free. Conclusions Nearly no specific clinical sym

关 键 词：纵隔肿瘤 神经源性肿瘤 临床特征 手术治疗 预后 

分 类 号：R734.5[医药卫生—肿瘤]