微创手术治疗后纵隔良性神经源性肿瘤42例报告

目的探讨后纵隔神经源性肿瘤微创手术治疗的方法和价值。方法 1993年5月～2009年3月,经微创手术切除42例后纵隔良性神经源性肿瘤。胸腔镜切除29例,其中16例加小切口辅助;脊柱旁小切口胸膜外切除10例;哑铃形肿瘤3例,均后正中切口切除椎管内肿瘤,1例胸腔镜切除胸内肿瘤,2例脊柱旁小切口胸膜外切除。结果 42例均完整切除肿瘤,无中转开胸。无并发症。病理诊断神经鞘瘤27例,神经纤维瘤7例,神经节细胞瘤8例。34例随访6个月～14年,其中3年16例,3～5年13例,5年5例。无局部复发。结论微创手术切除后纵隔良性神经源性肿瘤安全、可靠、创伤小。胸腔镜手术为首选治疗方法。对有胸膜粘连或肿瘤长入椎间孔者,应选择脊柱旁小切口胸膜外切除方法 。     

纵隔神经源性肿瘤的诊断和治疗

目的：探讨各种病理类型的纵隔神经源性肿瘤的临床表现、诊断要点、手术方法和预后。方法：回顾性分析外科手术治疗的110例（良性102例,恶性8例）纵隔神经源性肿瘤的临床资料。结果：本组住院死亡2例;8例出现合并症,主要为霍纳综合征和喉返神经麻痹。随诊良性肿瘤2例复发,4例恶性神经鞘瘤患者于术后3年内死亡。结论：绝大多数纵隔神经源性肿瘤为良性肿瘤;经胸部X线平片或CT可明确诊断;哑铃形神经源性肿瘤有其特殊的临床表现,诊断和手术方法不同;微创外科技术和电视辅助胸腔镜外科在部分病例有其特殊治疗价值;良性神经源性肿瘤完整切除后极少复发,恶性神经源性肿瘤预后不良。     

外科治疗纵隔原发神经源性肿瘤的手术径路评价

目的　探讨外科治疗原发纵隔神经源性肿瘤的手术径路。方法　 1963年 3月至2 0 0 3年 9月外科治疗原发纵隔神经源性肿瘤 91例。所有病例均于术前行X线胸片检查 ,其中 65例行CT或磁共振检查。根据肿瘤的大小、部位及其是否向椎管内延伸选择不同的手术入路 ,其中胸后外侧切口 84例 ,半哈壳状切口 2例 ,高位胸后侧切口 4例 ,胸后外侧加脊柱旁切口 1例。所有病例均经病理证实并行 6个月～ 15年的术后随访。结果　本组手术切除率 97.8% ( 89/91) ,术后并发症发生率 4.4% ( 4 /91) ,无手术死亡病例。术后病理诊断良性肿瘤 79例 ( 86.8% ) ,恶性肿瘤12例 ( 13 .4% )。 1例神经纤维瘤 2年后复发经再次手术切除治愈 ;恶性肿瘤平均生存 3 8.1个月。结论　适当的手术径路是提高纵隔原发神经源性肿瘤切除率的关键。     

胸腔镜手术治疗后纵隔良性神经源性肿瘤40例报告

目的 探讨胸腔镜在后纵隔神经源性肿瘤治疗中的价值. 方法 1994年5月～2006年5月,经胸腔镜手术切除40例后纵隔良性神经源性肿瘤,全麻双腔气管插管,套管切口根据肿瘤位置而定,如肿瘤过大,切除困难,可辅助小切口. 结果 34例经胸腔镜顺利完成肿瘤切除,6例附加6 cm小切口完成手术.神经鞘瘤20例,神经纤维瘤14例,神经节细胞瘤6例.肿瘤直径平均4.7 cm（2～12 cm）.术后平均胸腔闭式引流2.2 d（1～7 d）.术后平均住院4.8 d（3～13 d）.轻微并发症2例,无手术死亡.随访9个月～12年,其中＜3年16例,3～5年12例,＞5年7例,失访5例.局部复发1例,接受二次手术治疗. 结论 胸腔镜切除后纵隔良性神经源性肿瘤安全、可靠、创伤小,可作为该疾病的首选治疗方法.     

电视胸腔镜手术治疗后纵隔良性神经源性肿瘤

目的 探讨电视胸腔镜手术切除后纵隔良性神经源性肿瘤的临床疗效和价值. 方法 回顾性分析德阳市人民医院2008年3月至2012年4月运用电视胸腔镜手术切除后纵隔良性神经源性肿瘤24例的临床资料,其中男17例、女7例,年龄17～71 (41.25±14.78)岁;分析其安全性、有效性和危险性. 结果 全组24例均顺利完成手术,手术时间(114.25±52.30)min,手术出血量(214.45±123.12)ml,术中、术后输血2例,术后胸腔闭式引流时间(2.75±1.42)d,术后住院时间(7.25±3.26)d.全组24例中,19例在全胸腔镜下完成,3例哑铃型神经源性肿瘤采用胸腔镜联合背部小切口切除,2例中转开胸,中转开胸手术率8.33％.术后轻微并发症3例,无围手术期死亡.术后病理检查示神经鞘瘤10例,神经纤维瘤9例,神经节细胞瘤5例.术后24例均进行了随访,随访时间(21.23±18.56)个月,全组均生存,无复发. 结论 利用电视胸腔镜手术治疗后纵隔良性神经源性肿瘤安全、有效,但应严格掌握手术适应证及合理的手术方式,熟练掌握电视胸腔镜手术治疗后纵隔良性神经源性肿瘤的手术技巧,能有效地降低手术风险.     

纵隔肿瘤的外科治疗(附22例报告)

1985年3月至1997年2月,我院手术治疗纵隔肿瘤22例,其中前上纵隔9例,后上纵隔10例,后下纵隔3例;神经源性肿瘤10例,胸腺瘤8例,畸胎瘤4例。1例术后死于重症肌无力危象,其余治愈。本文对纵隔肿瘤的诊断和手术处理进行探讨,强调经胸壁穿刺细胞学检查为明确肿瘤性质的安全、简便方法,着重对胸腺瘤切除术后合并重症肌无力危象的预防和抢救提出自己的体会,介绍了胸内巨大纵隔肿瘤术中处理的经验。     

后纵隔神经源性肿瘤的外科治疗

目的探讨后纵隔神经源性肿瘤的临床特点和外科治疗策略,提高手术疗效。方法回顾性分析2003年8月至2008年8月收治的26例后纵隔神经源性肿瘤患者的临床资料,男16例,女10例;年龄12~68岁,平均年龄41.8岁。其中9例患者行常规开胸手术,17例在胸腔镜辅助下完成手术。累及椎管的哑铃型肿瘤5例,4例经后路椎管和侧胸两切口完成切除手术,1例直接经后胸径路手术。结果肿瘤位于纵隔右侧15例,左侧11例。肿瘤平均直径4.9 cm。神经鞘瘤19例（73%）,其中包括1例神经纤维瘤病,节细胞神经瘤6例（23%）,原始神经外胚层肿瘤1例（4%）。无手术死亡,其中2例哑铃型肿瘤患者因有轻微脑脊液漏,出现不同程度的头痛,2例患者因损伤一侧T4以上交感神经干,出现一侧上肢无汗。随访26例,随访时间2个月~5年,所有患者随访期间影像学检查未见肿瘤复发,无不适,恢复正常工作、生活。结论多数后纵隔神经源性肿瘤可经胸腔镜辅助完整切除,但对累及椎管内和胸廓出口处肿瘤应注意术前仔细评估,并进行有针对性的手术设计。     

82例纵隔原发神经源性肿瘤的外科治疗

1963年3月至2002年2月，我们手术治疗纵隔神经源性肿瘤82例，疗效满意。现报道如下。     

胸部微创联合脊柱后正中切口切除后纵隔哑铃形神经源性肿瘤（附3例报告）

后纵隔哑铃形神经源性肿瘤（dumbbell neurogenic tumors of the mediastinum）约占纵隔神经源性肿瘤的9．8％。多起源于后纵隔，通过椎间孔呈哑铃形向椎管内生长，亦可起源于椎管内向后纵隔生长，较少见，因解剖部位和解剖关系特殊，手术难度较大。2006年3月～2007年1月，我们手术治疗3例，取得良好效果，现报道如下。     

电视胸腔镜治疗后纵隔神经源性肿瘤

目的 利用电视胸腔镜切除后纵隔神经源性肿瘤,探讨该技术的操作特点.方法 2001年5月至2011年6月利用电视胸腔镜切除后纵隔神经源性肿瘤58例中男36例,女22例.平均年龄38.7岁.实体瘤平均最大径为4.9 cm.术前合并神经系统或肺部症状16例,无症状体检发现42例.病变位于左侧24例,右侧33例,双侧1例.手术通过3个切口完成,多采用包膜内剥除的方法,较大之滋养血管采用钛夹或Hem-o-lock夹闭;肿瘤来源神经者分别在瘤体两端正常神经束部位钛夹夹闭后剪断.如肿瘤巨大、粘连严重或出血时,延长前胸壁切口长约6 ～10 cm,转为开胸手术治疗.结果 全组手术顺利,无围手术期死亡.手术时间127.2 min,术中出血206.4ml,术中术后输血3例,术后胸腔闭式引流时间2.72天,住院5.19天.53例在全腔镜下完成手术,中转开胸5例.术后并发症7例,其中Homer综合征4例.术后病理亦神经鞘瘤25例,神经纤维瘤23例,神经节细胞瘤8例,副神经节细胞瘤1例,恶性副神经节细胞瘤1例.术后随访44.9个月,未见肿瘤复发.结论 利用胸腔镜治疗后纵隔神经源性肿瘤是一种安全、有效的手术方式,但需严格把握适应证并熟练掌握胸腔镜手术技巧.包膜内肿瘤切除是保障手术安全、减少手术并发症的重要手段.肿瘤直径超过6 cm时手术风险明显增加.胸膜顶肿瘤也是该类手术的难点之一.     

原发性纵隔肿瘤的诊断和外科治疗（附39例报告）

目的探讨原发性纵隔肿瘤的临床特征和诊疗方法。方法回顾性分析我院2002年1月至2007年10月39例原发性纵隔肿瘤外科诊治的临床资料。结果手术完整切除30例，姑息性切除9例。全组无手术死亡，术后32例获随访，随访3个月-5年。良性肿瘤患者术后均预后良好，恶性肿瘤出现远处转移2例，共3例在术后因肿瘤复发及其并发症而死亡。结论原发性纵隔肿瘤不论是良性还是恶性，只要无明确手术禁忌证均应及早手术，术后综合治疗是影响预后的重要因素。     

原发性纵隔畸胎瘤的诊断与外科治疗

目的探讨原发性纵隔畸胎瘤的诊断及外科治疗。方法对1996年3月至2006年3月49例纵隔畸胎瘤患者的临床资料进行回顾性分析。结果结合病史、体格检查、胸片X线、CT、MRI等术前确诊48例。所有患者均行手术治疗,其中完整切除46例,部分切除2例,探查活检1例。术中同时行肺楔形切除8例,部分心包切除6例。无手术死亡及术后并发症发生。术后均经病理证实为畸胎瘤,随访期间无复发病例。结论病史、体格检查与影像学检查是原发性纵隔畸胎瘤的主要诊断手段,手术治疗是有效的治疗方法。早期诊断以及根据肿瘤特点选择合理的手术方式是获得良好治疗效果的关键。     

Dumbbell neurogenic tumor of the mediastinum: A report of three cases undergoing single-staged complete romoval without thoracotomy

Of a total thirteen patients who underwent surgery for a neurogenic tumor in the posterior mediastinum 4 (30.8 per cent) presented with dumbbell type development of the tumor. Along with a comparatively greater incidence in the number of cases of dumbbell neurogenic tumors in the posterior mediastinum, resection has also recently become more popular, necessitating the establishment of a standard operative approach for this type of tumor. We successfully removed dumbbell neurogenic tumor from the posterior mediastinum in our 3 most recent casesvia a dorsal approach by virtue of a laminectomy and resection of a small portion of the neighbouring rib root without opening the parietal pleura at all. These three aptients were a 14 year old female, a 54 year old male and a 68 year old female, respectively, and the largest diameter in cm and level of origin of the tumors were 5.5 at Th 1 in case 1, 3.0 at Th 2 in case 2 and 3.7 at Th 11 in case 3. The operative approach described herein was easy to perform, felt secure and was less invasive and better tolerated by the patients than the thoractomy approach. Avoiding a thoractomy in such cases has many advantages to enumerate, but does not seem to have been clearly aimed at by others to date. We therefore propose our technique as a standard approach for dumbbell neurogenic tumors in the posterior mediastinum.     

Dumbbell neurogenic tumor of the mediastinum: a report of three cases undergoing single-staged complete removal without thoracotomy

Of a total thirteen patients who underwent surgery for a neurogenic tumor in the posterior mediastinum 4 (30.8 per cent) presented with dumbbell type development of the tumor. Along with a comparatively greater incidence in the number of cases of dumbbell neurogenic tumors in the posterior mediastinum, resection has also recently become more popular, necessitating the establishment of a standard operative approach for this type of tumor. We successfully removed dumbbell neurogenic tumor from the posterior mediastinum in our 3 most recent cases via a dorsal approach by virtue of a laminectomy and resection of a small portion of the neighbouring rib root without opening the parietal pleura at all. These three patients were a 14 year old female, a 54 year old male and a 68 year old female, respectively, and the largest diameter in cm and level of origin of the tumors were 5.5 at Th 1 in case 1, 3.0 at Th 2 in case 2 and 3.7 at Th 11 in case 3. The operative approach described herein was easy to perform, felt secure and was less invasive and better tolerated by the patients than the thoracotomy approach. Avoiding a thoracotomy in such cases has many advantages to enumerate, but does not seem to have been clearly aimed at by others to date. We therefore propose our technique as a standard approach for dumbbell neurogenic tumors in the posterior mediastinum.     

Dumbbell neuroblastomas in children.

A "dumbbell" neuroblastoma is a malignant neoplasm usually primary in the mediastinum or retroperitoneum with posterior extension through an intervertebral foramen to additional tumor within the spinal canal. Neurologic deficits are found in almost all cases. Nineteen patients with such tumors were reviewed with respect to diagnosis, management, and results. Treatment consisted of prompt laminectomy with total or subtotal excision of the extradural tumor. The primary tumor in the mediastinum or retroperitoneal area was removed at a second stage. All patients received postoperative radiation therapy. Eleven of the 17 patients observed more than two years are free of disease, a cure rate much higher than the overall experience with neuroblastoma. Substantial recovery of neurologic function occurred in most, but kyphoscoliotic deformities were a disturbingly frequent late complication.     

Mediastinal masses in children

A variety of mediastinal masses may present in children. Imaging is generally confined to chest radiograph and CAT scan of the chest, although other studies may prove helpful depending upon the circumstances. MRI is particularly helpful for neurogenic tumors in the posterior mediastinum. The most common tumor in the anterior mediastinum is lymphoma with germ cell tumors second. In general, lymph nodes in areas outside the mediastinum provide access for tissue diagnosis when lymphoma is present. Germ cell tumors are generally benign, but surgical excision is indicated to rule out malignant elements and to treat symptoms which are often present through compression of nearby structures. Neurogenic tumors are the most common lesions in the posterior mediastinum.     

Benign neoplasms and cysts of the mediastinum.

Benign neoplasms and cysts are the most common tumors of the mediastinum. However, they are still an infrequent clinical entity. Their diagnosis has been aided by the recent advances in CT scanning, MRI, ultrasonography, radionucleotide scanning, and fine-needle aspiration. The treatment of these benign tumors in children and the majority of adults is excision. In asymptomatic adults, observation or fine-needle aspiration and observation may be considered for pericardial cysts and selected neurogenic tumors and bronchogenic cysts.     

Neurogenic tumors of the mediastinum in children]

The age peak of neurogenic tumors of the mediastinum in children is from 2 to 7 years, malignant tumors being more frequently observed at the age before 2 years, benign tumors after 2 years of age. The method of choice in treatment of benign neurogenic tumors is operation. The selection of the method for treatment of malignant tumors depends on the stage of the disease: operative treatment is necessary for the I-II stages, the III-IV stages are better treated by radiation therapy and polychemotherapy. The survival of patients with mediastinum neuroblastomas made up 61.1%.