倒"L"形切口在颈胸交界处肿瘤切除术中的应用  

Reverse"L"surgical approach in resection of cervicothoracic junction tumor

作　　者：钟元 杨旭晖 蒋连勇[1] 王磊[1] 谢晓[1] 胡睿[1] 毕锐[1] 姜兆磊[1] 梅举[1] 王明松 Zhong Yuan;Yang Xuhui;Jiang Lianyong;Wang Lei;Xie Xiao;Hu Rui;Bi Rui;Jiang Zhaolei;Mei Ju;Wang Mingsong(Department of Cardiothoracic Surgery,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Thoracic Surgery,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

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第九人民医院胸外科,上海200011

出　　处：《中华解剖与临床杂志》2021年第4期455-459,共5页Chinese Journal of Anatomy and Clinics

基　　金：国家自然科学基金(81772459)。

摘　　要：目的:探讨倒"L"形切口在颈胸交界处肿瘤切除术中的临床应用。方法:回顾性研究。纳入2015年8月—2019年8月上海交通大学医学院附属新华医院心胸外科21例颈胸交界处肿瘤患者的临床资料,其中男12例、女9例,年龄13~76岁。11例患者术前穿刺病理检查:神经来源6例,甲状腺组织来源3例,淋巴组织来源2例。均采用倒"L"形切口行肿瘤切除术,观察手术时间、术中出血量、患者住院时间以及术后乳糜漏、膈肌麻痹、喉返神经损伤、肺部感染等并发症发生情况。结果:本组21例患者,单纯应用倒"L"形切口切除肿瘤共16例,中转全胸骨劈开1例,应用胸腔镜辅助4例。手术时间130~350 min,平均214 min;术中出血量100~500 mL,平均236 mL;患者住院时间为3.5~10.0 d,平均7.5d。术后1例患者因单侧喉返神经损伤出现声音嘶哑,1例患者出现乳糜胸,1例患者出现单侧膈肌麻痹。所有患者术后肩部及上胸部形态满意,无肢体功能障碍,无切口感染,无再次手术。术后病理提示神经源性肿瘤7例,甲状腺来源肿瘤3例,畸胎瘤3例,淋巴瘤3例,支气管源性肿瘤2例,血管瘤2例,脂肪瘤1例。21例患者随访时间3.0~40.0个月,平均20.3个月。在随访期间,15例患者存活且无肿瘤复发及转移,6例患者死亡。结论:在颈胸交界处肿瘤的切除术中,倒"L"形切口能安全、完整地切除肿瘤。此切口特别适用于瘤体大部分位于颈根部的肿瘤。Objective To investigate the applicability of applying the reverse"L"surgical approach in the resection of cervicothoracic junction tumor.Methods This retrospective study included 21 patients who underwent the reverse"L"surgical approach in the resection of cervicothoracic junction tumor at Xinhua Hospital affiliated with Shanghai Jiao Tong University School of Medicine from August 2015 to August 2019,including 12 males and 9 females,aged 13 to 76 years.Preoperative pathology indicated six cases of neurogenic tumor,three cases of thyroid tumor,and two cases of lymphoma.The following variables were examined:operation time,intraoperative blood loss,patients'length of hospital stay,and surgical complications.Surgical complications included postoperative chylous leakage,diaphragmatic paralysis,recurrent laryngeal nerve injury,and pulmonary infection.Results Sixteen cases were resected by the reverse"L"surgical approach alone,one case was converted to traditional full sternum splitting,and four cases were assisted by thoracoscopy.Operation time was 130-350 min(mean 214 min).Intraoperative blood loss was 100-500 mL(mean 236 mL).Postoperative hospitalized time was 3.5-10.0 days(mean 7.5 days).Among 21 patients,hoarseness occurred in one case,lymphatic leakage occurred in one case,and hemidiaphragm paralysis occurred in one case.All patients were satisfied with the physical without limb dysfunction,incision infection,and reoperation.Postoperative pathology indicated seven cases of neurogenic tumor,three cases of thyroid tumor,three cases of teratoma,three cases of lymphoma,two cases of bronchogenic tumor,two cases of hemangioma,and one case of lipoma.Average follow-up time was 3.0-40.0 months(mean 20.3 months).During follow up,15 patients survived without tumor recurrence or metastasis,and six patients died.Conclusions Applying the reverse"L"surgical approach in the resection of cervicothoracic junction tumor can safely and completely remove the tumor.This incision is especially suitable for tumors where most of the tumo

关 键 词：肿瘤 颈胸交界处 手术切口 

分 类 号：R730.56[医药卫生—肿瘤]