恶性胸腺瘤侵犯大血管的手术治疗及术后生存调查

目的分析恶性胸腺瘤患者的手术方式及其预后,以期寻找到侵犯大血管的恶性胸腺瘤的最佳治疗方案。方法回顾性总结2003年1月至2008年12月期间有明确肿瘤侵犯大血管的患者19例,其中行Y型血管置换术2例,行双根人工血管置换6例,行单根上腔静脉和(/或)其属支置换术6例,行上腔静脉和(/或)其属支成形术5例。5例患者行主动脉和(/或)其属支外膜剥离。13例患者同时切除受侵犯肺组织,行解剖学肺段切除2例,行肺叶切除11例。12例患者因肿块完全侵犯膈神经,行单侧膈神经切除11例,行双侧膈神经切除1例。结果 19例患者平均生存期44.1(3～114)个月。1年生存率88.2%(15/17),3年生存率64.7%(11/17),5年生存率50%(4/8)(截至2012年10月)。结论恶性胸腺瘤侵犯上腔静脉和无名静脉并致梗阻不应成为纵隔肿瘤局部根治性切除的禁忌。掌握手术指征和禁忌,争取根治性切除是提高生存率的关键。术后的后续治疗,尤其是放疗,也是延长患者生存时间的因素之一。

Surgical Management and Prognosis Analyze of Thymoma Invading the Great Vessels

Objective To explore the surgical methods and the prognosis of the patients with malignant thymoma with great vessels invasion, so as tO find the best treatment options for malignant thymoma. Methods A retrospective review of the results in 19 patients treated at the Second Xiangya Hospital of Central South Uni- versity by a single surgeon team, between January 2003 and December 2008, who underwent resection of invasive thymoma that included either the SVC or its branches, with or without invasion of other organs. All procedures were performed via median stemotomy. Some angioplasty techniques were successfully used to resect and recon- struct the SVC. 13 of the 19 patients underwent pulmonary resection due to involvement of pulmonary parenchy- ma. Results There was no perioperative death. 1 patients suffered from prolong ventilation after surgery. Up to October 2012, the median follow-up duration for all patients was 44.1 （3 ~ 114） months. The 1-year survival rate was 88.2% （15/17） , the 3-year survival rate was 64.7% （11/17） , and the 5-year survival rate was 50% （4/8）. The remaining 6 patients were still living and their progress was still monitored. Conclusion Thy- moma invading the SVC system can he safely and completely resected via a median stemotomy, even if it has in- vaded other medianstinal organs. A good outcome for patients with invasive thymoma is possible if a suitable strategy combining accurate diagnosis and appropriate treatment, especially surgical resection is afforded.