巨大纵隔肿瘤的外科治疗  

Surgical strategy for giant mediastinal mass

作　　者：蒋连勇[1] 沈赛娥[2] 梅举[1] 王明松[1] 肖海波[1] 胡丰庆[1] 胡睿[1] 李国庆[1] 谢晓[1] 

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海200092 [2]上海交通大学医学院附属新华医院麻醉科,上海200092

出　　处：《中国胸心血管外科临床杂志》2017年第10期753-759,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金项目(81201540)

摘　　要：目的介绍巨大纵隔肿瘤的外科治疗及围术期处理经验。方法回顾性分析2007年1月至2016年7月上海市新华医院心胸外科治疗21例巨大纵隔肿瘤患者的临床资料,其中男14例、女7例,年龄11个月~79岁,平均年龄(34.62±22.95)岁,体质量10.8~90.5(58.07±22.24)kg。分析其临床表现、麻醉方法、外科治疗及预后。结果肿瘤体积最大25 cm×25 cm×8 cm,最小8 cm×6 cm×6 cm。胸部正中切口12例,前外侧切口5例,后外侧切口1例,胸骨"L"型切口2例,颈胸联合"]"型切口1例。所有患者肿瘤均完全切除,其中1例分期完成手术,12例肿瘤侵犯其他组织需同时切除。手术时间55~480(207.86±87.67)min,术中出血量600(10~4 000)ml,术中输血量800(0~4 100)ml,术后呼吸机辅助时间4.75(0~87)h,术后引流时间3~12(7.43±2.66)d,术后总引流量295~4 940(1 584.76±1 173.98)ml,平均日引流量62~494(204.90±105.76)ml,术后住院时间7~47(11.86±8.51)d。术后并发症包括:心包积液1例,霍纳综合征1例,左侧喉返神经损伤合并左侧膈神经损伤1例,右侧膈神经损伤1例和切口愈合不良1例。其余患者恢复顺利。所有患者随访1个月~9年,截至2016年9月1日,5例死亡,2例肿瘤复发,其余患者目前未见肿瘤复发。结论巨大纵隔肿瘤患者经充分评估后进行手术治疗安全性好,围术期死亡率低,良性肿瘤治疗效果好。Objective To introduce the surgical and perioperative strategy for giant mediastinal mass. Methods The clinical data of 21 patients with giant mediastinal mass who underwent surgical treatment in Xinhua Hospital of Shanghai from January 2007 to July 2016 were retrospectively reviewed. There were 14 males and 7 females, with a mean age of 34.62±22.95 years （range： 11 months to 79 years）, and mean weight of 58.07±22.24 kg （range： 10.8 to 90.5 kg）. Their clinical manifestation, anesthesia methods, surgical treatment and the prognosis were analyzed. Results The tumor volume ranged from 8 cm×6 cmx6 cm to 25 cm×25 cmx8 cm. For surgical approach, 12 patients received median sternotomy, 5 anterior lateral incision, 1 posterior lateral incision, 2 ＂L＂-shape sternotomy, 1 cervical and thoracic ＂J＂-shape incision. All patients were given mass radical resection, except one patient with two-stage resection. Twelve patients needed other tissues resection besides the single tomor resection. The operation time was 55-480 （207.86_＋87.67） min, blood loss volume 700 （10-4 000） ml, intraoperative blood transfusion 800 （0-4 100） ml,and delayed wound healing in 1. The remaining patients recovered well. All patients were followed up for 1 month to 9 years. Till September 1, 2016, 5 patients died and 2 suffered recurrent tumor. Conclusion It is safe to perform surgical treatment after comprehensive evaluation of patients with giant mediastinal mass, perioperative mortality is low, and prognosis in patients with benign tumor is good.

关 键 词：纵隔肿瘤 巨大肿瘤 外科手术 麻醉管理 

分 类 号：R734.5[医药卫生—肿瘤]