巨大纵隔畸胎瘤的临床特点和外科治疗

目的探讨巨大纵隔畸胎瘤的临床特点和外科治疗.方法回顾分析1989年12月至2003年12月我院收治并经病理证实的巨大纵隔畸胎瘤36例患者的临床资料.结果本组男21例,女15例.年龄13～63岁,其中35岁以下31例.病变位于左前纵隔者14例,右前纵隔22例.肿瘤最大直径10～15 cm 21例,15～20 cm 9例,＞20 cm 6例.肿瘤外穿10例,其中继发肺感染6例,胸腔感染2例,心包感染1例.病理证实囊性畸胎瘤25例,实性畸胎瘤11例,其中3例镜检有恶性细胞,诊断为恶性畸胎瘤.肿瘤完整切除34例,次全切除2例,其中合并前外侧心包大部切除4例,合并肺叶切除3例,不规则肺叶切除2例,右全肺1例.结论巨大纵隔畸胎瘤临床和X线CT表现复杂,外侵和粘连严重,手术治疗时应注意切口和术式的选择,严防术中意外出血.     

纵隔良性畸胎瘤的诊断及外科治疗特点

目的探讨纵隔良性畸胎瘤的诊断及外科治疗特点。方法对1966年～1997年收治的132例纵隔良性畸胎瘤患者的临床资料进行回顾性分析。结果本组患者的主要症状为胸痛、胸闷、气短、咳嗽及痰中带血。纵隔良性畸胎瘤术前易误诊为胸腺瘤及肺癌等。本组术前误诊率高达31．1％（41／132）。影像学检查肿瘤位于后纵隔1例，位于前纵隔131例。43例胸片或胸部CT有肿瘤钙化。所有患者均行肿瘤切除，根治性切除率88．6％（117／132），其中16例同时行肺切除，10例行部分心包切除，17例损伤血管并予以修补。手术并发症发生率22．0％（29／132），无手术死亡。结论纵隔良性畸胎瘤易被误诊。前纵隔肿物在CT检查表现有囊性、厚壁、钙化及脂肪密度等特点时应首先考虑良性畸胎瘤可能。外科手术时应注意切口选择及避免损伤血管、神经。     

小儿骶尾部畸胎瘤的发病特点与外科治疗

目的 总结小儿骶尾部畸胎瘤的发病特点与外科治疗。方法 对1985～2003年间收治的73例骶尾部畸胎瘤患者的临床资料进行回顾性分析。结果 本组73例均经手术治疗，病理检查证实良性63例，恶性10例。随访1～18年，10例恶性者因肝肺转移1～2年死亡。4例良性复发者经过二次手术2例痊愈，1例大小便失禁，1例下肢无力。其余59例发育良好，无并发症。结论 术中减少出血，保护输尿管和直肠避免骶丛神经损伤．完整切除肿瘤和尾骨，是减少并发症和复发率的必要措施。     

17例巨大纵隔肿瘤的外科治疗

１７例巨大纵隔肿瘤的外科治疗南京市第三医院（南京市２１０００８）孙凯，吴坚巨大纵隔肿瘤临床上较为少见。我们自１９８４年３月至１９９３年１１月，共收治巨大纵隔肿瘤１７例，均经手术切除治愈。现针对巨大纵隔肿瘤的诊断要点、肿瘤切除的相关问题及侵犯肺部时的处...     

纵膈肿瘤17例诊治体会

自1991年4月至1996年7月,手术治疗并经病理证实原发纵隔肿瘤17例。其中胸腺瘤3例,畸胎瘤3例,纵隔囊肿4例,神经源性肿瘤3例,其他肿瘤4例。本组治愈15例,死亡2例。认为体积巨大的前纵隔肿瘤,仰卧位麻醉手术有潜在危险,应慎重对待。     

颈部外穿性纵隔畸胎瘤的诊治体会

纵隔畸胎瘤较常见 ,而纵隔畸胎瘤外穿至颈部则十分罕见。我院自１９６２年１月～１９９８年３月经外科手术及病理证实的纵隔畸胎瘤５２例 ,仅３例发生颈部外穿 ,其发生率为５．７７%。由于此症在临床诊断和治疗上有其特殊之处 ,极易误诊 ,现将３例的诊治经验和体会报告如下。１材料与方法本组共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 ,２例 ;诊断为甲状舌管瘘１例。术前经窦道碘油造影、胸片及胸部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…     

儿童骶尾部畸胎瘤临床分析

目的:回顾性分析儿童骶尾部畸胎瘤的诊断及治疗经验。方法:49例骶尾部畸胎瘤患儿,男性12例,女性37例。按Altman分类法,I型19(38.78%)例,Ⅱ型14(28.57%)例,III型11(22.45%)例,IV型5(10.20%)例。临床表现主要为骶尾部包块、排便困难等。所有病例均手术切除肿瘤及尾骨,48例经骶尾部手术,1例经腹和骶尾部联合手术,2例病理恶性者术后行BEP方案辅助化疗。结果:43例患儿获得随访,中位随访时间47个月(3-106个月),41例随访的良性畸胎瘤患儿均未出现复发。1例成熟畸胎瘤合并卵黄囊瘤患儿术后化疗6疗程,未复发。1例卵黄囊瘤患儿术后化疗6疗程后复发行二次手术,术后4年死于肝脏及盆腔转移。结论:儿童骶尾部畸胎瘤以良性居多。早期诊断、早期手术预后好,术中完整切除尾骨及避免肿瘤破溃是预防复发及恶变的关键,对于恶性畸胎瘤彻底手术切除辅助术后化疗也可达到较高生存率。     

纵隔血管源性肿瘤的诊治分析——附5例报告

回顾性分析5例经病理证实的纵隔血管瘤的临床表现、诊断方法和治疗，并对全部患者进行随访。其中3例生存已达8-12年。纵隔血管源性肿瘤诊断困难，良性纵隔血管瘤没有复发、转移及恶性倾向。肿瘤的位置、大小及手术切除范围与预后无关。     

巨大纵隔肿瘤的外科治疗

目的回顾总结28例巨大纵隔肿瘤的诊断要点及外科治疗经验.方法对1980～2002年收治的28例巨大纵隔肿瘤的临床资料进行回顾分析.结果28例中全部切除23例姑息性切除5例,其中肺楔形切除2例,肺叶切除1例,部分心包切除5例,上腔静脉成形1例,无手术死亡.结论胸部X线、CT及B超是巨大纵隔肿瘤诊断的重要手段;麻醉时体位及手术切口的选择、术中操作技术注意可提高手术的安全性及切除率,应注意创面渗血及复张性肺水肿的防治.     

椎管内先天性肿瘤的诊断与治疗——附135例分析

背景与目的：椎管内先天性肿瘤临床表现多样，治疗上也各不相同。本研究旨在总结椎管内先天性肿瘤的诊断与治疗方法。方法：回顾性分析2000年1月至2005年4月经手术和病理明确诊断的135例椎管内先天性肿瘤的病理类型、部位、临床症状和体征、影像学检查及手术治疗方法和疗效。结果：表皮样囊肿35例．脂肪瘤26例，肠源性囊肿24例，皮样囊肿24例，畸胎瘤19例，脊索瘤7例。全切39例，近全切除52例，大部切除44例。术后症状好转100例，无变化22例，加重13例。无手术死亡。结论：椎管内先天性肿瘤多为良性．MRI和显微外科技术的应用改善了椎管内先天性肿瘤的诊断和治疗。     

14例巨大纵隔肿瘤的外科治疗

目的:探讨巨大纵隔肿瘤的诊断、治疗方法及其疗效.方法:分析手术治疗14例巨大纵隔肿瘤的临床资料.结果:14例中完整切除9例,部分切除5例.1例术后出现急性肺水肿,2例术后出现呼吸衰竭,均治愈,无围手术期死亡.术后随访半年至8年,良性肿瘤术后疗效好,恶性者术后主要死于复发及远处转移.结论:选择合适的麻醉和手术方式治疗巨大纵隔肿瘤效果肯定,术中可选择分块或整块切除,防止避免大出血和复张性肺水肿.恶性者术后辅助化疗和(或)放疗以减少复发.     

26例原发性纵隔恶性生殖细胞瘤的诊治

目的:探讨原发性纵隔恶性生殖细胞瘤的诊治及外科手术的作用.方法:对26例收治的原发性纵隔恶性生殖细胞瘤的临床资料进行回顾性分析.结果:22例手术治疗患者中,11例根治性切除,10例姑息性切除,1例探查,手术并发症发生率及死亡率分别为18.2%和9.1%,其中12例术后给予以顺铂为主的联合化疗,4例予以放疗.手术治疗患者术后病理为无性生殖细胞瘤12例,精原细胞瘤5例,未成熟畸胎瘤5例.3例未成熟畸胎瘤及1例胚胎癌患者明确诊断后未手术而给予放疗或放、化疗.本组26例患者中仅2例精原细胞瘤生存满5年,17例已证实死亡,除2例手术死亡外均死于肿瘤复发转移.结论:原发性纵隔恶性生殖细胞瘤的治疗应强调以化疗为主的综合治疗,外科切除只宜做为阶段性的辅助手段,手术时机把握应以具体患者情况而定.     

前后侧联合入路切除大腿巨大软组织肉瘤

目的介绍经前后侧联合入路并结扎股深动脉切除大腿巨大软组织肉瘤的经验。方法对初发或复发的8例大腿巨大软组织肉瘤术前常规行MRI和DSA检查，采用经前后侧联合入路并结扎股深动脉行肿瘤广泛切除术，其中1例行术前化疗及术后放疗，3例行术后放疗，3例术后局部复发再次行广泛切除术后放疗，1例术前术后均无辅助治疗。结果8例中2例术后出现切口边缘皮肤坏死，1例经换药治愈，1例行局部推移皮瓣术后治愈。8例术后随访2～6年，4例无瘤正常生存，3例1～2年内局部复发再次行广泛切除术，术后无瘤正常生存，1例无任何辅助治疗者术后多次局部复发行姑息性局部切除术，6年后因全身衰竭死亡。结论对初发或复发的大腿巨大软组织肉瘤术前常规行MRI和DSA检查评估其局部切除的可行性，采用经前后侧联合入路并结扎股深动脉行肿瘤广泛切除术，术后辅助放疗，是较好的保肢治疗方法。术后局部复发是较常见的并发症，再次行复发灶广泛切除术及术后放疗仍可取得较好的疗效。     

胸部巨大肿瘤切除术前介入栓塞的临床应用

为了探讨胸部巨大肿瘤切除术前介入栓塞的临床应用价值,对7例经胸部CT确诊的胸部巨大肿瘤患者行手术前介入栓塞治疗。栓塞术后第2天行肿瘤切除术。造影可见参与肿瘤供血动脉均为多支,增粗、迂曲,远端分支增多、杂乱。7例患者均顺利切除肿瘤,无介入栓塞及外科手术相关并发症发生,手术中平均出血量较以往未行术前栓塞者明显减少,手术时间也明显缩短。初步治疗体会,对胸部巨大肿瘤切除术前栓塞肿瘤供血动脉可明显减少术中出血、缩短手术时间、减少并发症发生,是一种安全有效的治疗方法。     

Growing teratoma syndrome of ovary

Growing teratoma syndrome is an increase of tumor size containing only a mature teratoma component, during or after chemotherapy for germ cell tumors. Mature teratomatous elements are chemoresistant and have to be resected surgically. We describe three patients with malignant immature teratoma treated with chemotherapy and surgical resection. All three had an increase in the size of the mass after chemotherapy, surgery was possible, and histology revealed mature teratoma. One of the patients showed fluorodeoxy glucose positron emission tomography (FDG-PET) positivity for growing teratoma syndrome, but the histology revealed only mature teratoma. All three patients are alive, at 55, 72, and 103 months’ follow up after the initial diagnosis. Data collected from the literature are reviewed. Early recognition of this syndrome is essential as it offers hope for curative resection and avoids the use of ineffective chemotherapy.     

Sacrococcygeal teratoma in adults: case reports and a review of the literature.

BACKGROUND: The sacrococcygeal area is the most frequent site of teratoma in infants, but it is a rare location for teratoma in adults. METHODS: The authors report two patients in their sixth decade of life with the pathologic diagnosis of sacrococcygeal teratoma. The clinical presentations, the histologic findings, and the patients' clinical outcomes are described. A review of the literature on sacrococcygeal teratoma in adults is also presented. RESULTS: In the first patient, who had no evidence of recurrence after adequate resection, examination of the specimens showed mature teratoma. The second patient had mature teratoma with adenocarcinomatous component and possible leptomeningeal involvement. She died 2 months after the operation. CONCLUSIONS: Although rare in adults, sacrococcygeal teratoma should be considered in the differential diagnosis of patients with a pelvic mass presenting with obstructive symptoms. These two cases suggest that sacrococcygeal mature teratoma is surgically curable if teratoma is completely resected. The presence of leptomeningeal involvement and malignant transformation are associated with a less favorable outcome.     

PRIMARY CHONDROSARCOMA OF THE LUNG

Five cues of primary chondrosarcoma, a rare tumor of the lung, are reported. The diagnosis should be made by pathology. The diagnosis can not be made in some conditions including: (1) tumor from the chest wall; (2) chondroaarcoma of bone discovered after operation; (3) ovarian teratoma found prior to operation; (4) patient with history of hamartoma of the lung; and (5) atypical pathology. It has no close relation tetween pathologic subtyping and prognosis of the disease. The main cause of death was intralobar spread of the lung. Extrathoracic metastasis was no observed and surgical resection is the primary option of therapeutic management for this tumor.     

Two resected cases of pulmonary adenocarcinoma with intralober metastasis diagnosed by the pathological diagnosis during the operation

We described two resected cases of pulmonary adenocarcinomas with intralober pulmonary metastasis diagnosed by the frozen section diagnosis. The first case was a 61-year-old female who underwent an operation as a left S4 pulmonary adenocarcinoma which was 2 cm in size, and a left S3 pulmonary nodule which was 3 mm in size, was suspected pulmonary metastasis by CT scan. In September 2007, a partial resection of the left lung S3 was performed at first and the result of the frozen section diagnosis of this tumor was adenocarcinoma. The segmentectomy of the left lung S4, a partial resection of the left lung S6 and S3, and dissection of the lymphnodes (#6, 11) were performed. The final pathological diagnosis was pulmonary adenocarcinoma pT3N0M0=Stage IIB, pm1. The new metastasis of the right lung occurred in 2009, a partial resection of the right lung and systemic chemotherapy were performed. The second case was a 60-year-old female who underwent an operation as a right S10, S6, S2 pulmonary ground grass opacity (GGO) nodules which were 0.5 to 1 cm in size, was suspected pulmonary adenocarcinoma by CT scan. In June 2009, a partial resection of the right lung S10 was performed at first and the result of the frozen section diagnosis of this tumor was adenocarcinoma. Following this diagnosis, a partial resection of the right lung S6, and dissection of the lymphnodes (#7, 10) were performed and these results of the frozen section diagnosis were lung S6 tumor: adenocarcinoma, and the lymphnodes: no malignancy. The additional resection of the right lung S2, S8 was performed, the final pathological diagnosis was pulmonary adenocarcinoma pT-3N0M0=Stage IIB, pm1. After the operation, a systemic chemotherapy was performed.     

肺炎性假瘤诊断及外科治疗71例

目的：总结肺炎性假瘤诊断及外科治疗体会，方法：对1970年12月－2000年12月71例肺炎性假瘤的临床资料进行回顾性分析。女49例，男22例，年龄23－72岁，平均45．2岁，肺叶切除44例，楔形切除18例，肺段切除8例，探查活检1例，术中冰冻病理切片13例，肺炎性假瘤11例，错构瘤1例，可疑腺癌1例，术后病理考虑恶性变5例。结果：5例恶性变者，3例已生存5年，2例术后5年内死于复发，转移，余66例预后良好，结论：术前诊断较困难，治疗以手术切除为主，术中冰冻病理切片检查对决定术式有帮助。