颈胸交界处肿瘤的手术入路和方法  

Surgical strategies and approaches for the management of tumors at cervicothoracic junction

作　　者：王帅 谭黎杰 葛棣 亓发芝 张勇 竺挺 陈增淦 蒋伟 王群 Wang Shuai;Tan Lijie;Ge Di;Qi Fazhi;Zhang Yong;Zhu Ting;Chen Zenggan;Jiang Wei;Wang Qun(Department of Thoracic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Plastic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Vascular Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Orthopedic Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院胸外科,上海200032 [2]复旦大学附属中山医院整形外科,上海200032 [3]复旦大学附属中山医院血管外科,上海200032 [4]复旦大学附属中山医院骨科,上海200032

出　　处：《中华胸心血管外科杂志》2021年第6期358-362,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨颈胸交界处肿瘤的个性化手术治疗方法。方法回顾性分析2008年3月至2020年5月期间在复旦大学附属中山医院胸外科接受手术治疗的63例颈胸交界处肿瘤患者临床资料,其中男30例,女33例;年龄15~74岁,平均48岁,中位年龄51岁。合并高血压、糖尿病、室上性心动过速等慢性疾病15例,吸烟20例,0.1~2.0包/天。无症状查体发现43例,≥1个症状者20例。术式包括开放性手术36例,胸腔镜根治性切除手术22例,胸腔镜探查联合锁骨上切口3例,胸腔镜探查联合后外侧切口1例,胸腔镜探查联合半蛤壳(Hemiclamshell)切口1例。其中开放性手术包括前路术式24例(锁骨上切口13例,经胸骨切口8例,经锁骨切口2例,胸骨正中劈开1例)、前外侧术式8例(Hemiclamshell切口6例,天窗切口2例)、后路术式1例、后外侧术式2例、锁骨上切口联合后外侧切口1例。分析患者临床表现、手术径路、切除程度及肿瘤类型等。结果术后病理显示R0切除61例(96.8%),R1切除2例。神经鞘瘤27例,纤维组织来源肿瘤6例。总体3年生存率88.9%(56/63),总体5年生存率84.1%(53/63)。结论颈胸交界处肿瘤位置特殊,解剖复杂,病理类型多样。个体化的手术入路及治疗方法有助于颈胸交界处肿瘤治疗的安全性、规范化。Objective To investigate the surgical treatment of the tumors at cervicothoracic junction.Methods A retrospective analyses was performed for 63 patients with tumors at the cervicothoracic junction receiving surgery from Mar 2008 to May 2020 in the Department of Thoracic Surgery,Zhongshan Hospital,Fudan University.Clinical data about manifestation,surgical approach,resection degree and pathological types were collected.There were 43 cases of asymptomatic patients and 20 cases of patients with≥1 clinical manifestations.Twenty two patients receiving radical resection with video-assisted thoracoscopic surgery.Anterior approach was the most popular treatment in open surgery(24 cases,38.1%),and 8 cases of anterolateral approach(6 cases of Hemiclamshell incisions,2 cases of trap-door incisions),1 case of posterior approach,2 cases of posterolateral approach and 1 case of supraclavicular combined posterolateral approach.Results Pathological examination suggested 61 cases of radical resection and 2 cases of microscopic residual.Neurilemmoma was the most common pathological type(27 cases,42.9%),the second common pathological type was tumor originated from fibrous tissues(6 cases,9.5%).The 3-year overall survival rate of those 63 patients was 88.9%,while the 5-year overall survival rate was 84.1%.Conclusion Tumors involving the cervicothoracic junction are characterized as special location,complicated anatomy and various histopathological subtypes.Individualized approach and surgery improve safety and normalization of tumors at cervicothoracic junction treatment.

关 键 词：肿瘤 颈胸交界区 手术入路 半蛤壳切口 

分 类 号：R730.56[医药卫生—肿瘤]