纵隔畸胎瘤21例诊治分析

目的探讨纵隔畸胎瘤的诊断要点及治疗策略。方法对1995年至2005年我院收治的纵隔畸胎瘤21例的临床资料进行分析。结果21例均行肿瘤切除,其中3例同时行肺切除。结论纵隔畸胎瘤有其自身的组织学特点,但临床表现特征甚少,CT检查呈囊性、厚壁、钙化及脂肪密度改变对诊断价值较大;纵隔畸胎瘤侵蚀性强易与周围组织粘连,手术治疗难度较大。     

纵隔畸胎瘤的临床特点与外科治疗

目的 总结纵隔畸胎瘤的临床特点和外科治疗经验。方法 对1993年1月～2005年12月收治的67例纵隔畸胎瘤患者的临床资料进行回顾性分析。所有患者均行手术治疗，经胸部前外侧切口径路手术切除纵隔畸胎瘤26例，后外侧切口径路手术23例，电视胸腔镜加辅助小切口手术8例，电视胸腔镜手术（VATS）5例，胸骨正中切口径路手术5例。结果 本组无手术死亡。术后病理检查证实均为畸胎瘤，其中62例为成熟畸胎瘤，4例为不成熟畸胎瘤（其中Ⅰ级1例、Ⅱ级2例、Ⅲ级1例）。术后发生肺部感染3例，肺水肿1例，肺不张2例，上肢功能障碍1例。经相应的处理除1例患者上肢功能未恢复外，其余患者均痊愈出院。术后随访61例，6例失访，随访时间1～12年，无肿瘤再发。结论 纵隔畸胎瘤经外科手术治疗效果良好，手术时应注意切口的选择，术中避免损伤神经、血管等。     

纵隔神经源性肿瘤的外科治疗

目的总结纵隔神经源性肿瘤的诊断及外科治疗。方法对我院1996年3月至2006年3月收治的57例纵隔神经源性肿瘤患者的临床资料进行回顾性分析。结果完整切除55例,部分切除1例,探查活检1例。发生手术相关并发症1例。术后均经病理证实为神经源性肿瘤。结论早期诊断以及根据肿瘤特点选择适宜的手术方法是获得良好治疗效果的关键。     

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。     

单孔胸腔镜下前纵隔支气管囊肿切除26例

目的探讨单孔胸腔镜下前纵隔支气管囊肿切除的治疗效果。方法回顾性分析2009年3月至2015年4月我院26例前纵隔支气管囊肿患者的临床资料,其中男17例、女9例,平均年龄32.4(25~51)岁。均行单孔胸腔镜手术治疗,分析其临床症状、影像学特点及手术疗效。结果本组26例患者平均手术时间62.0(48~110)min,平均出血量98.4(60~120)ml,术后平均住院时间8.7(6~12)d。术后25例患者无手术并发症,1例术后因不配合主动咳嗽,出现肺不张及胸腔积液,给予调整胸腔引流管,加强咳嗽后恢复良好。术后平均随访9.6(1~18)个月,复查CT均无复发。结论前纵隔支气管囊肿难以根据影像学诊断,最终需术后病理检查确诊。单孔胸腔镜手术可作为治疗前纵隔支气管囊肿首选方法。     

颈部外穿性纵隔畸胎瘤

我们自1962年1月～1998年3月收治纵隔畸胎瘤52例,3例发生颈部外穿,发生率5.77%,现报告如下。1　临床资料与方法本组共3例,男1例,女2例。年龄14～22岁。因颈部包块而诊断为胸腺咽管瘘、胸骨结核、寒性脓肿2例,诊断为甲状舌管瘘1例。术前经窦道碘油造影、胸部X线片及胸部CT检查均未能明确诊断。手术采用颈部切口、纵劈胸骨切口及全胸骨切除,术中完整切除窦道及周围病变组织,切除标本中均有毛发。术后病理诊断均为(前上纵隔)囊性畸胎瘤(附图)。附图　窦道造影片注:A为胸部正位片;B为侧位片2　结　　果3例患者经外科手术治疗后,均痊愈出院。3…     

巨大纵隔肿瘤的外科治疗

目的回顾性总结28例巨大纵隔肿瘤的诊断要点及外科治疗经验。方法28例巨大纵隔肿瘤患者在全身麻醉双腔气管内插管下行手术治疗,完整切除肿瘤23例,大部分切除5例;同期行肺楔形切除术2例,肺叶切除术1例,部分心包切除术5例,上腔静脉成形术1例。结果无手术死亡患者,术中发生复张性肺水肿2例,失血性休克6例,损伤上腔静脉1例;术后发生心律失常3例,肺部感染4例,经治疗均恢复良好。结论巨大纵隔肿瘤手术治疗效果良好,麻醉时体位及手术切口的选择、术中仔细操作可提高手术的安全性及切除率,预防和治疗术中创面渗血及复张性肺水肿可进一步提高疗效。     

原发性骶前肿瘤的诊断与手术治疗（附8例临床分析）

为探讨原发性骶前肿瘤的诊断和手术方法,分析2007-2010年治疗的8例原发性骶前肿瘤患者的临床资料。结果显示,5例经骶尾部切除,1例经腹切除,1例经腹骶联合切除,1例经腹会阴联合切除。术后病理类型：表皮样囊肿2例,皮样囊肿（良性畸胎瘤）1例,脂肪瘤1例,平滑肌瘤1例,淋巴管囊肿1例,恶性纤维组织细胞瘤1例,恶性畸胎瘤1例。术后无严重并发症。随访12～24个月,无死亡病例。结果表明：（1）直肠指诊、直肠腔内超声、CT检查、MRI检查对术前评估有重要意义;（2）原发性骶前肿瘤应行手术切除,根据肿瘤情况选择手术方法,完整切除肿瘤。     

原发性纵膈肿瘤的外科治疗

目的 探讨原发性纵隔肿瘤的诊治方法.方法 对52例经手术并病理证实的原发性纵隔肿瘤患者的临床资料进行回顾性分析,并就其诊断和治疗问题进行讨论.结果 良性肿瘤50例,恶性肿瘤2例,均经手术切除.术后并发症11例,10例经治疗3 d～2周后治愈,1例死于呼吸功能衰竭.术后随访:50例良性肿瘤患者中1例术后1 a发生重症肌无...     

呼吸系统外支气管囊肿20例外科治疗

目的探讨发生于呼吸系统外器官的支气管囊肿的临床特点及外科治疗方式。方法回顾性分析我院2002年1月一2013年3月间收治的20例呼吸系统外支气管囊肿患者的临床资料,总结其临床症状、影像学特征及手术方式。结果20例呼吸系统外支气管囊肿,位于前纵隔15例,食管壁内5例。术前均未能明确诊断,术后由病理确诊。就诊时有症状14例（70％）。15例前纵隔支气管囊肿均行完整肿物摘除术,其中7例胸腔镜手术,1例因胸腔闭锁而中转开胸,1例术后出现液气胸、肺不张。5例食管壁内支气管囊肿均开胸切除,其中1例拟采用胸腔镜手术,因无法摘除中转开胸,3例完全剥除囊肿,另2例分别行部分剥除和食管胃部分切除。全组病例均痊愈出院。术后平均随访54（4—122）月未见复发。结论呼吸系统外的支气管囊肿因其位置特殊及临床表现多样,术前诊断较为困难,应通过综合多种影像检查来诊断。治疗上应根据囊肿的情况灵活选择手术方式,前纵隔支气管囊肿建议行胸腔镜下切除,食管壁内支气管囊肿则选择开胸手术。     

13例肾上腺畸胎瘤临床诊疗分析并文献复习

目的探讨肾上腺畸胎瘤(adrenal teratoma,AT)的临床特征及外科诊疗方法,以提高对该病的认识。方法收集2012-10—2019-03间郑州大学第一附属医院收治的13例AT患者的临床及随访资料,对其进行回顾性分析并复习国内外相关文献。结果13例患者中,男1例(7.7%),女12例(92.3%);中位年龄31岁。左侧8例(61.5%),右侧5例(38.5%)。3例(23.1%)因腹部不适或胀痛就诊,10例(76.9%)均为体检时发现。10例行腹腔镜肾上腺切除术,3例行开腹肾上腺切除术,均未发生围手术期并发症,术后病理示肾上腺成熟性畸胎瘤。术后均获5~81个月随访,13例均预后良好,无复发或癌变。结论AT是一种罕见的生殖细胞来源肿瘤,发病年龄跨度大,临床表现缺乏特异性。术前诊断主要依靠影像学检查。完整切除肿瘤是AT治疗的关键,成熟性AT手术切除预后良好;未成熟性AT术后易复发,需辅助放、化疗,且需终身随访。     

Mature mediastinal teratoma with somatic type malignancy including neuroblastoma and intestinal type of adenocarcinoma: A Case Report

Introduction and importanceThe majority of mediastinal tumours develop asymptomatically and are often detected incidentally on a chest X-ray performed for another reason. Mediastinal tumours, although mostly asymptomatic, may cause non-specific symptoms associated with advanced tumour growth.Case presentationWe present a case of a 30-year-old woman who presented with exhaustion and lower back pain accompanied by severe headaches with symptoms of visual disturbances, followed by the typical Horner syndrome. Computed tomography revealed a tumour measuring 12 × 11 × 10 cm in the right cavity with features suggestive of teratoma. The patient underwent mediastinal tumour resection and thymectomy. The pathomorphological examination confirmed the primary diagnosis of mediastinal teratoma, but rare somatic type malignancy was detected. Therefore, the patient was referred for further oncological treatment.DiscussionMediastinal teratoma is an uncommon finding and usually asymptomatic. Despite its slow growth, it can grow enough to compress adjacent structures, causing symptoms similar to those presented in our patient.ConclusionRadiologic imaging proves diagnostic in most cases. Despite the somatic type malignancy, surgical excision of the tumour using the en-bloc technique seems to be a sufficient option for the patient, and further oncological treatment is not always obligatory.     

Teratoma following cisplatin-based combination chemotherapy for nonseminomatous germ cell tumors: a clinicopathological correlation

From April 1975 through May 1981, 51 patients had teratoma resected from residual disease following cisplatin-based combination chemotherapy. All patients had normal serum markers before resection of abdominal (25), lung (12), mediastinal (5), thoracoabdominal (8) or other (1) disease. Teratoma was classified as mature in 29 cases, immature in 15 or immature with nongerm cell elements in 7. Of the 51 patients 31 (61 per cent) remain free of recurrent disease, while 20 either had recurrent carcinoma (10) or teratoma (10) requiring further therapy. Nine patients died, including 1 in whom angiosarcoma developed, which was thought to be secondary to previous radiation therapy. In 4 patients the initial relapse of carcinoma developed beyond 2 years after resection. Univariate factors predicting for relapse include tumor burden, immature teratoma with nongerm cell elements and site (mediastinum), while only immature teratoma with nongerm cell elements and site predicted for survival. Patients with immature teratoma had a comparable relapse-free and over-all survival as those with mature teratoma. Using a multivariate analysis, primary tumor site at the mediastinum was the most significant adverse factor predictive for relapse and survival. This study appears to support the various pre-clinical models that demonstrate multipotential capabilities of teratoma. Complete surgical excision of teratoma remains the most effective treatment with continued close followup recommended for high risk patients (immature teratoma with nongerm cell elements, large tumor burden and primary mediastinal tumors) with resected teratoma.     

Mediastinal germ cell tumors in childhood. A clinical and pathological study of 21 cases

Twenty-one patients aged 16 years or less had been treated for a primary mediastinal germ cell tumor at the Children's Hospital, Boston Massachusetts, during the last 54 years. There were 13 boys and eight girls with the average age at diagnosis being 7 years (range 2 weeks to 16 years). Twelve mediastinal germ cell tumors were classified as pure teratoma, five contained embryonal carcinoma admixed with other germ cell components, and four were pure embryonal carcinoma. Of 12 patients with pure teratoma, 10 underwent complete surgical resection and were alive and well 1 to 13 years later; two children left untreated died of complications related to local tumor growth. Complete surgical resection was possible for only two of nine patients with embryonal carcinoma; both received adjuvant therapy and were alive and well 3 and 20 years later. Seven patients received radiation and/or chemotherapy but died of residual or metastatic disease. Successful treatment for children with embryonal carcinoma requires an operation aimed at either debulking or complete resection (if possible) coupled with early and aggressive combination chemotherapy. The role of radiation in primary therapy remains undefined with regard to curative intent.     

原发性十二指肠癌38例的诊治体会

目的探讨原发性十二指肠癌的诊断与治疗方法。方法回顾性分析38例原发性十二指肠癌的临床资料。结果肿瘤位于球部4例,降部30例,水平部2例,升部2例。腺癌33例。上腹部压痛22例,无阳性体征3例,腹块3例,黄疸10例。钡餐、B型超声、CT、纤维十二指肠镜以及经内镜逆行胰胆管造影（ERCP）对十二指肠肿瘤有诊断价值。38例中30例行胰十二指肠切除术,3例行节段性十二指肠切除术,5例行姑息性手术。切除率为86．8％。23例得到随访,随访率为60．5％,1年生存率为76．4％,3年生存率为43．7％,5年生存率为33．5％。结论纤维十二指肠镜和ERCP是诊断本病的可靠方法,手术切除是治疗的主要手段。肿瘤部位不同,手术方法也不一样。十二指肠乳头上方肿瘤以胃十二指肠切除为主,乳头下方以十二指肠节段性切除为主,乳头周围肿瘤根据肿瘤生物学特性选择胰十二指肠切除术或经十二指肠肿瘤局部切除。     

成人先天性胆管扩张症的诊断与治疗

目的探讨成人先天性胆管扩张症的诊断与治疗。方法回顾分析我院1985年至2004年30例成人先天性胆管扩张症的临床资料。结果28例行B超检查,确诊率为92.9%(26/28)。5例CT、4例ERCP、3例PTC、6例MRCP检查均全部确诊。本组30例确诊率100%。手术27例,其中囊肿内引流术5例,术后疗效欠佳,囊肿切除肝管空肠Roux-Y吻合术20例,疗效满意。全组无手术死亡。结论上腹痛是成人先天性胆管扩张症最常见的临床表现,结合影像学检查可确诊,囊肿切除肝管空肠Roux-Y吻合术为首选术式。     

Resection of thoracic and abdominal teratoma in patients after cisplatin-based chemotherapy for germ cell tumor. Late results

Fifty-one patients with primary testicular (N = 46) or mediastinal germ cell cancer (N = 5) were treated from April, 1975, through May, 1981, and had teratoma resected from residual disease after cisplatin-based combination chemotherapy. All patients had normal serum markers before resection of pulmonary (N = 12), mediastinal (N = 5), thoracoabdominal (N = 8), supraclavicular (N = 1) or abdominal disease (N = 25). Teratoma was classified as mature teratoma (N = 29), immature teratoma (N = 15), or immature teratoma with non-germ cell elements (N = 7). Thirty of 51 (60%) patients remain free of recurrent disease, whereas 20 patients have either recurrent carcinoma (N = 10) or teratoma (N = 10). One patient has a presumed second malignancy. After additional chemotherapy, four patients with recurrent carcinoma are alive and disease free and six have died. After an additional operation, eight of 10 patients with recurrent teratoma are long-term survivors. In four patients the initial relapse of carcinoma developed more than 2 years after therapy; in an additional patient carcinoma recurred after a 32 month disease-free survival period. Univariate factors predicting for relapse include tumor burden, immature teratoma with non-germ cell elements, and site (mediastinum), whereas only immature teratoma with non-germ cell elements and site predicted for survival. Immature teratoma and mature teratoma had similar relapse-free intervals and overall survival intervals. According to a multivariate analysis, primary tumor site at the mediastinum is the most significant adverse factor predictive for both relapse and survival (two of five patients survived). This study appears to support the various preclinical models that demonstrate multipotential capabilities of teratoma. Complete surgical excision of teratoma remains the most effective treatment with continued close follow-up recommended for high-risk patients (immature teratoma with non-germ cell elements, large tumor burden, or primary mediastinal tumors.     

踝关节色素沉着绒毛结节性滑膜炎早期诊断与治疗

[目的]探讨踝关节色素沉着绒毛结节性滑膜炎的早期诊断与手术疗效。[方法]回顾性分析5例踝关节色素沉着绒毛结节性滑膜炎患者资料，左侧2例，右侧3例；年龄18～50岁；病程2～12a。5例早期均被误诊。均行滑膜切除术后放射治疗。[结果]随访1～4a，平均2．5a，治愈2例，好转3例，未见复发。[结论]该病早期诊断困难，临床、放射学及病理检查相结合是确诊关键；滑膜切除术后结合放射治疗疗效确切。     

Video-assisted thoracoscopic management of anterior mediastinal masses

The author reports his personal experience on the management of anterior mediastinal masses using video-assisted thoracoscopic surgery (VATS) at a single institution. From August 1993 to March 1995, 24 patients (14 males and 10 females ranging in age from 9 to 76 years old) with anterior mediastinal masses were diagnosed or treated by VATS. This consisted of 11 biopsies and 13 resections (11 thymectomies and 2 thymic cystectomies). Seven biopsies were performed for primary histological diagnosis (four non-Hodgkin's lymphoma, two metastatic carcinoma, one yolk sac tumor) and four biopsies were performed to detect residual tumors following chemotherapy. Complete thymectomy was accomplished in all 11 cases by examination of the thymic bed and resected specimen. We have reserved this approach for resection of benign masses only. Adequate biopsy for histological diagnosis was obtained in all 11 cases to guide further management. There was no surgical mortality or intraoperative complications. The median postoperative hospital stay for the entire group was 3 days. We conclude that VATS for resection or biopsy of an anterior mediastinal mass is technically feasible and provides an alternative to the conventional approaches in selected patients.