Grunenwald切口在颈胸交界处手术中的应用  

Clinical application of Grunenwald incision in cervicothoracic junction surgery

作　　者：徐延昭[1] 张缜[1] 张月峰[1] 吕会来[1] 李振华[1] 朱永刚[1] 苏鹏[1] 孙博康 田子强[1] Xu Yanzhao;Zhang Zhen;Zhang Yuefeng;Lyu Huilai;Li Zhenhua;Zhu Yonggang;Su Peng;Sun Bokang;Tian Ziqiang(Department of Thoracic Surgery,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院胸五科,石家庄050011

出　　处：《中华胸心血管外科杂志》2023年第7期409-413,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：河北省科技厅-河北医科大学"厅校会商基金-科技创新"项目(2020TXZH04)。

摘　　要：目的探讨Grunenwald切口应用于颈胸交界处手术中的临床效果。方法回顾性分析2011年12月至2021年9月期间河北医科大学第四医院胸外科单治疗组25例颈胸交界处肿瘤和1例颈胸交界处外伤患者的临床资料,其中男19例,女7例;年龄9~73岁,平均(50.50±17.27)岁。包括上纵隔肿瘤9例,肺上沟瘤6例,甲状腺肿瘤侵犯上纵隔4例,胸壁肿瘤4例,食管癌锁骨上淋巴结转移癌2例,颈胸交界处异物贯通伤1例。全组采用Grunenwald切口或附加胸部后外侧切口、胸骨正中切口、颈部领状切口。评估肿瘤切除程度,观察手术时间、术中出血量、住院时间,分析术后随访情况。结果全组无围手术期死亡。应用单纯Grunenwald切口14例,附加胸部后外侧切口6例,附加颈部领状切口4例,附加胸骨正中切口2例。肿瘤完全切除22例,姑息切除3例,完整取出异物1例。术后病理证实神经鞘瘤4例,肺腺癌、甲状腺癌、肌纤维母细胞瘤各3例,肺鳞癌、食管癌锁骨上淋巴结转移癌各2例,肺大细胞神经内分泌癌、肺鳞癌术后单纯第1肋骨转移癌、节细胞神经瘤、结节性甲状腺肿、血管瘤、高分化脂肪肉瘤、血管内皮源性肿瘤、海绵状脉管瘤各1例。手术时间120~430 min,平均(226.92±88.40)min;术中出血量100~1000 ml,平均(273.46±196.34)ml;患者住院6~26天,平均(12.73±4.46)天。随访6~130个月,平均(57.88±43.64)个月,随访期间死亡6例。结论Grunenwald切口能够良好暴露颈胸交界处附近结构,并保留胸锁关节完整性,减少肩部畸形,可用于颈胸交界处肿瘤、高位肋骨切除及颈胸交界处外伤治疗。Objective To investigate the clinical application of Grunenwald incision in cervicothoracic junction surgery.Methods The clinical data of 25 patients with cervicothoracic junction tumor and 1 patient with cervicothoracic junction trauma in the single treatment group of Department of Thoracic Surgery,the Fourth Hospital of Hebei Medical University from December 2011 to September 2021 were analyzed retrospectively,including 19 males and 7 females,aged 9-73 years old.Among the 26 patients,there were 9 cases of upper mediastinal tumor,6 cases of superior sulcus tumor,4 cases of thyroid tumor invading the upper mediastinal,4 cases of chest wall tumor,2 cases of esophageal cancer combined with supraclavicular lymph node metastasis,and 1 case of foreign body penetrating injury at the cervicothoracic junction.Grunenwald incision or additional posterolateral thoracic incision,median sternal incision,neck collar incision were used in all patients.The degree of tumor resection was evaluated.The operation time,intraoperative blood loss,length of hospital stay were observed,and the postoperative follow-up was analyzed.Results There was no perioperative death in the whole group.14 cases were treated with Grunenwald incision alone,6 cases with additional posterolateral chest incision,4 cases with additional neck collar incision,and 2 cases with additional median sternal incision.The tumors were completely resection in 22 cases,palliative tumor resection in 3 cases,and complete foreign body removal in 1 case.Postoperative pathology included 4 cases of schwannoma;3 cases of lung adenocarcinoma,thyroid cancer and myofibroblastoma,respectively;2 cases of supraclavicular lymph node metastasis of esophageal cancer and lung squamous carcinoma,respectively;1 case of large cell neuroendocrine carcinoma,metastatic carcinoma of the first rib after lung squamous cell carcinoma,ganglioneuroma,nodular goiter,hemangioma,well differentiated liposarcoma,vascular endothelial tumor and cavernous angioma,respectively.The operation time was 120-430

关 键 词：Grunenwald切口 肿瘤 颈胸交界处 手术切口 

分 类 号：R730.56[医药卫生—肿瘤]