电视胸腔镜手术在肺恶性肿瘤合并气胸诊断和治疗中的应用

目的探讨电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）对肺恶性肿瘤合并气胸的诊断和治疗价值。方法 2002年4月～2008年5月,19例术前胸部CT提示单侧周围型肺肿瘤合并气胸,术前均无明确病理诊断,行VATS手术探查,术中取肺肿瘤组织快速冰冻切片,根据病理结果和病人情况决定手术方式,同时处理肺脏漏气部位。结果全胸腔镜肺肿瘤楔形切除10例,胸腔镜辅助小切口手术9例（其中原发肺癌根治4例,肺肿瘤射频消融5例）。14例肺转移瘤均行胸膜摩擦固定。均手术顺利,均明确病理诊断。手术时间45～90 min（平均51.4 min）,术中出血量50～280 ml（平均150 ml）,胸管引流时间3～8 d（平均4.5 d）。术后2例轻度漏气,无特殊处理自愈,无围手术期死亡。术后所有患者肺复张良好。19例术后随访2～49个月,平均23个月,仅1例气胸复发,行胸腔闭式引流治愈。结论 VATS对明确周围型肺肿瘤病理诊断有重要作用,同时及时有效治疗气胸和肺恶性肿瘤,值得推荐。     

电视胸腔镜手术治疗食管平滑肌瘤

目的探讨电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）治疗食管平滑肌瘤的应用价值。方法2000年7月-2007年10月应用VATS治疗食管平滑肌瘤19例,全身麻醉,侧卧位,根据食管肿瘤位置,选取3个1.5-2.0 cm胸壁切口,作为胸腔镜观察口及操作口,术中胃镜辅助操作。结果电视胸腔镜食管平滑肌瘤切除18例;1例术前诊断3cm×2 cm食管平滑肌溜,术中证实为巨大平滑肿瘤,中转开胸。术后恢复顺利,无手术死亡及严重并发症,术后病理诊断均为平滑肌瘤。19例随访5-35个月,平均24.5月,无复发。结论电视胸腔镜肌瘤切除术可作为食管平滑肌瘤的首选治疗方法,对于较大食管平滑肌瘤应考虑开胸手术。     

电视胸腔镜手术治疗恶性胸腔积液37例临床分析

目的探讨电视胸腔镜手术治疗恶性胸腔积液的方法,总结其临床经验。方法回顾性分析2009年1月至2011年12月宝鸡市中心医院37例恶性胸腔积液患者的临床资料,男21例、女16例,年龄43～75岁。其中肺癌15例,乳腺癌7例,食管癌7例,胃癌4例,胸膜间皮瘤3例,卵巢癌1例;均为单侧胸腔积液,其中左侧胸腔积液22例,右侧胸腔积液15例。所有患者均行电视胸腔镜手术（VATS）或VATS辅助小切口完成手术,在电视胸腔镜下行胸膜剥脱术,并喷洒滑石粉固定胸膜。结果围术期无死亡,7例（18.9%）延长切口,手术时间（40.32±19.06）min,术中出血量（90.09±41.03）ml,术后（7.31±2.08）d拔除胸腔引流管,术后住院时间（9.02±3.11）d。手术有效率100%,其中完全缓解19例（51.4%）。术后出现轻度并发症,如肺部感染、持续性漏气和切口感染等,经对症处理治愈。结论电视胸腔镜治疗恶性胸腔积液是一种微创、有效、实用的治疗方法。     

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（或辅助小切口）手术治疗食管良性肿瘤56例临床体会

目的总结电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）治疗食管良性肿瘤的临床经验。方法1995年3月-2008年1月,对56例食管良性肿瘤施行电视胸腔镜（或辅助小切口）手术。在纤维胃镜辅助下,手术采用一个1.5cm左右胸腔镜进镜口加2个2cm左右操作孔或辅助腋下5cm左右小切口完成食管良性肿瘤摘除。结果54例顺利完成VATS（其中8例辅助小切口）食管良性肿瘤摘除术,术后病理证实为食管平滑肌瘤47例,间质瘤7例。1例因平滑肌瘤巨大,食管肌层破坏严重且术中冰冻切片病理检查报告肿瘤生长活跃,1例因术中冰冻切片病理报告低度恶性平滑肌瘤,均中转开胸行食管部分切除、食管胃端侧吻合术。无手术期及围手术期死亡,无术后严重并发症发生。49例随访2-128个月,平均58.6月,无明显进食梗噎等症状出现或复发。结论VATS（或辅助小切口）食管良性肿瘤摘除术具有安全、彻底、有效、可行等特点,可作为食管良性肿瘤摘除术的首选治疗方法。     

电视胸腔镜手术治疗自发性气胸（附126例报告）

目的总结电视胸腔镜手术（video—assisted thoracoscopic surgery，VATS）治疗自发性气胸的经验。方法2001年5月-2007年8月，对126例自发性气胸行VATS，其中同期双侧VATS12例，胸腔镜辅助小切口21例（1例行右肺上叶、右下肺大疱切除）。肺大疱用内镜缝合切割器切除或结扎，生物蛋白胶喷覆创缘，不用胸膜固定术。结果术后平均住院7．4d（3～26d），胸腔引流管放置平均5．4d（1～14d）。术后并发症10例（2例剖胸止血）。全部病例治愈，随访3个月～6年，无气胸复发。结论VATS是彻底性治疗自发性气胸的首选方法，肺大疱切除是常用术式，疗效确切、微创、安全。     

电视胸腔镜手术治疗肺包虫53例报告

目的探讨电视胸腔镜手术（video-assited thoracoscopic surgery,VATS）治疗肺包虫的价值。方法 2001年9月～2011年1月行电视胸腔镜肺包虫手术53例。全麻双腔气管插管,单肺通气,腋中线第7肋间做1.5 cm小切口,置入胸腔镜,结合术前CT检查,另取2个1.5 cm小切口,术中用髙渗盐水纱布垫于穿刺点周围以保护胸腔,三通针头在病变最高点刺入囊内,待内囊液抽吸干净后,切开外囊壁,将内囊完整切除并置于标本袋中移出胸腔。结果手术时间65～120 min,平均86.5 min;术中出血100～180 ml,平均130 ml。3例术后发生支气管胸膜瘘,VATS直接以无损伤编织线缝合封闭瘘口,外用生物蛋白胶。31例随访0.5～6年,平均2.5年,无复发。结论 VATS治疗肺包虫安全、有效。     

胸腔镜肿瘤切除术治疗肺错构瘤5例报告

目的：探讨胸腔镜肿瘤切除术治疗肺错构瘤的临床效果。方法双腔气管插管单肺通气,根据肿瘤部位常规做3个胸腔镜切口：腋中线第7或8肋间作为观察口,置入胸腔镜;腋前线第5肋间和腋后线第6肋间作为操作口。胸腔镜下切开结节表面脏层胸膜,沿肿瘤包膜钝性剥离出肿瘤。结果5例手术顺利,无中转开胸,无手术并发症和围术期死亡发生。手术时间平均54 min（30～90 min）,术中出血平均10 ml,引流量平均288 ml（220～350 ml）,术后拔管时间平均2．6 d （2～3 d）、术后住院时间平均3．8 d（3～5 d）,总费用平均23940．51元（15885．95～26670．23元）。5例术后随访1～30个月,平均9．2月,未见肿瘤复发。结论胸腔镜肿瘤切除术是周围型肺错构瘤的首选术式。     

胸腔镜手术在胸部创伤治疗中的应用

目的探讨胸腔镜在胸部创伤手术中的应用价值。方法 2004年8月～2011年6月对225例胸部创伤施行电视胸腔镜手术(video-assisted thoracoscopic surgery,VATS)或胸腔镜辅助小切口手术进行血胸清除、止血、肺修补、心包开窗、膈疝修补、胸内异物取出等操作。结果 206例行VATS,19例行胸腔镜辅助小切口手术。手术时间25～125 min,平均58min。术后24 h胸腔引流液30～320 ml,平均179 ml。术后胸腔闭式引流管放置时间1～5 d(2例脓胸胸管放置时间分别为16、21 d,未计算在内),平均2.7 d。术后住院时间5～45 d,平均9.8 d。223例术后随访3个月,无中等量以上(>1000 ml)胸腔积液,无再次胸部手术者,恢复良好。结论胸腔镜诊断和治疗胸部创伤,创伤小,术后恢复好,疗效满意。     

胸腔镜下胸顶壁层胸膜切除术治疗自发性气胸

目的探讨胸腔镜下胸顶壁层胸膜切除治疗自发性气胸的可行性及其临床效果。方法21例自发性气胸患者均行胸腔镜手术治疗,术中肺尖部发现肺大疱15例,未发现肺大疱6例。肺尖部肺组织局部切除17例,结扎法处理肺大疱4例;20例行胸顶壁层胸膜切除,1例继发性气胸除胸顶胸膜切除外同时行滑石粉胸膜固定术。留置多侧孔胸顶引流管,引流量少于100ml／d后拔除。结果无中转开胸。手术时间平均87（60～192）min;术中出血量平均47（20～100）ml。手术后拔管时间平均4（3～7）d。无切口感染,无术后胸腔活动性出血。术后胸部X线发现胸顶胸膜增厚8例。术后平均随访12（6～30）月,无复发。结论胸顶壁层胸膜切除在胸腔镜手术治疗自发性气胸中可以作为有效的胸膜固定方法,对于术中未发现明显肺大疱者尤为重要。     

Successful diagnosis of diaphragmatic solitary fibrous tumor of the pleura by preoperative ultrasonography

The diaphragm is an uncommon site for solitary fibrous tumors of the pleura (SFTPs). Diaphragmatic SFTPs are usually found as pedunculated tumors with a clear margin with their surrounding structures. However, preoperative diagnosis of the tumor is difficult because their morphological features are not well detected on radiological images. We presented a case of diaphragmatic SFTP that was successfully diagnosed by ultrasonography (US). The US revealed a well-circumscribed mass with the feeding arteries leading from the diaphragm. Subsequently, this finding was confirmed histopathologically after resection. US can be less invasive and more sensitive than radiological examinations for diagnosing diaphragmatic SFTPs. To our knowledge, this is the first report of a preoperative diagnosis of diaphragmatic SFTP by US.     

Solitary fibrous tumor of the pleura with a minute malignant component and diaphragmatic vascular supply: Report of a case

We resected a fist-sized, solitary fibrous tumor of the pleura (SFTP) with a minute malignant component, following percutaneous embolization of its feeding artery. The tumor had macroscopic characteristics of a benign SFTP, and most parts of it were microscopically benign. However, further careful pathological examination revealed a minute malignant component in its periphery. We report this case to show that large and mostly benign SFTPs may contain malignant components, which can be overlooked. Thus, large SFTPs should be resected in consideration of this possibility.     

胸膜孤立性纤维瘤的诊治

目的 探讨胸膜孤立性纤维瘤的诊断和治疗方法.方法 回顾性分析2002年至2007年10例胸膜孤立性纤维瘤病人的临床和病理资料.10例中男3例,女7例.术前行超声引导下粗针穿刺活检明确诊断2例.全组均行手术治疗,其中3例行胸腔镜手术切除.结果 组织病理学报告,良性和恶性肿瘤各5例;恶性肿瘤CD34表达阳性率较低(3/5例),其中CD34阴性者nestin表达均阳性.失访1例,其余9例随访6～35个月,平均17.3个月,复发1例,死于脑转移1例.结论 超声引导下粗针穿刺结合免疫组化检查是术前明确诊断的一种较好方法.对于较小带蒂的肿瘤,胸腔镜手术是最佳手术方法.CD34阴性,同时nestin表达阳性可能是胸膜孤立性纤维瘤的一个恶性指标.     

Solitäre fibröse Pleuratumoren

Solitary fibrous tumors of the pleura (SFTP) are very rare neoplasms. The majority of these tumors are benign, but about 10-20 % fulfill the criteria of malignancy. The clinical presentation varies according to the size and intrathoracic localization. In early stages, often asymptomatic, the tumors may grow to an enormous size and then cause symptoms such as cough, chest pain and dyspnea, but also paraneoplastic syndromes such as hypoglycemia or digital clubbing. Between 1981 and June 1998 we treated in our institution 16 SFTP in 14 patients (4 M, 10 F, average age at first operation 58 years). Eight patients showed symptoms, whereas in the other cases the tumors were found on routine chest X-rays. The usually pedunculated SFTP were completely resected without complications. Two patients developed malignant recurrences, which infiltrated the right upper lung lobe and the diaphragm respectively. In these cases the tumor was resected together with the adjacent structures. Since late recurrences are more often malignant than primary SFTPs long-term follow-up is mandatory even in benign lesions.     

Diagnosis, treatment and long-term outcome of solitary fibrous tumours of the pleura.

OBJECTIVE: Solitary fibrous tumours of the pleura (SFTP) are rare and can histologically be differentiated into benign and malignant forms. The aim of this study is to present new cases, and discuss up-to-date preoperative examinations, the role of video-assisted thoracic surgery and long-term outcome. METHODS: Between 1993 and 2006, 27 SFTPs were diagnosed (14 females, mean age+/-SD, 62.3+/-9.6 years) at our institution. Medical records were reviewed, and follow-up was obtained by repeated examinations or contact with general practitioners. RESULTS: SFTPs were associated with symptoms in 63% of all cases. In the six patients in which positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) was performed preoperatively, malignant lesions were all found to be positive. Complete resection was achieved by video-assisted thoracic surgery in 15 and anterolateral thoracotomy in 12 patients. Mean hospital stay was shorter for patients operated by video-assisted thoracic surgery compared to thoracotomy, 4.5 (range 3-6) versus 7.5 (range 4-25) days, respectively (p<0.01). Histology revealed 17 benign and 10 malignant SFTP. Mean+/-SD tumour diameter of malignant SFTPs was larger than in benign forms, 11.9+/-7.1 versus 6.1+/-3.5 cm, respectively (p<0.01). Tumour recurrence was recognised in four patients with malignant SFTPs at a median time interval after surgery of 38 (range 6-122) months, two late deaths occurred resulting from tumour recurrences. CONCLUSIONS: SFTPs can be treated minimally invasively by video-assisted thoracic surgery with short hospital stay. Large SFTPs with increased FDG-uptake have a high likelihood for malignancy. Long-term follow-up is mandatory in malignant SFTPs because of late recurrences associated with death.     

Resection of a giant, invasive malignant solitary fibrous tumor of pleura

Solitary fibrous tumor of pleura (SFTP) is a rare mesenchymal neoplasm that most commonly involves the pleura, is probably derived from fibroblasts, and has no relationship to malignant mesothelioma. Here, we report a case of complete resection of a giant malignant SFTP. A 61-year-old woman developed fever and left flank pain. Computed tomography revealed the tumor to be 13?cm in size and located in the left thoracic cavity, directly invading the left lower lobe of the lung. The patient underwent radical resection and left lower lobectomy. Immunohistochemical examination revealed a dense proliferation of spindle-shaped cells with ovoid nuclei and collagen fibers hyperplasia. The cells were positive for CD34 and vimentin, and were negative for cytokeratin AE1/AE3, calretinin, S-100 and smooth muscle ??-actin. SFTPs have malignant potential, as 20?C30?% of resected SFTPs reportedly contain malignant components. Careful long-term clinical follow-up is therefore required for all cases of SFTP.     

Solitary fibrous tumor of the pleura: morphogenesis and progression. A report of 36 cases

Purpose

We attempted to identify the exact point of tumor eruption of a solitary fibrous tumor of the pleura (SFTP).

Methods

We morphologically classified 36 SFTPs into 5 categories. Type A showed a connection that included a bloodstream with the pleura on both sides. Type B only showed a connection that included a bloodstream with the visceral pleura, and had a non-bloodstream connection with the parietal pleura. Type C only showed a connection that included a bloodstream with the visceral pleura, and had no connection with the parietal pleura. Type D showed a non-bloodstream connection with the visceral pleura, and only showed a connection that included a bloodstream with the parietal pleura. Finally, type E had no connection with the visceral pleura, and only showed a connection that included a bloodstream with the parietal pleura. The clinicopathological profiles of the tumors were investigated according to their type.

Results

The distribution of the 36 SFTPs was as follows: A (19 %), B (6 %), C (67 %), D (0 %) and E (8 %). The tumors categorized as type A tended to be large in size.

Conclusions

SFTPs commonly arise from the visceral pleura and in accordance with tumor progression they will form a non-bloodstream connection with the parietal pleura. Finally, a vascular pedicle will arise with the parietal pleura.

     

Benign solitary fibrous tumour of the pleura: a clinical review and report of six cases

Primary tumours of the pleura are commonly divided into two major categories: diffuse and localised. Whereas the diffuse variant is known for its association with asbestos and its poor outcome, the localised one is rare and remains a subject of controversy. Electron microscopy and immunohistochemistry have recently demonstrated that these tumours are of mesenchymal rather than mesothelial origin, and therefore the term "localised mesothelioma" was abandoned. Such tumours are now called solitary fibrous tumours of the pleura (SFTP). The Authors describe a series of 6 cases of benign solitary fibrous tumours of the pleura, surgically treated over the period 1982-2000.     

Extrapleural pneumonectomy for relapsed solitary fibrous tumors of the pleura with pleural dissemination

We report a case of a 62-year-old female with a prior thoracotomy for solitary fibrous tumor of the diaphragmatic pleura. There was no clear evidence of malignant solitary fibrous tumor of the pleura (SFTP). In the 19th postoperative month, she had a disseminated recurrence of SFTP in the left thoracic cavity. There was no evidence of metastasis from medical imaging. Accordingly, a left extrapleural pneumonectomy was performed. Pathological examination revealed a disseminated recurrence of malignant SFTP, showing a higher grade of malignancy, because the resected specimen was identical to the only section suspicious of malignancy in the previous tumor. She had no complaint and kept better performance status until the 7th postoperative month after the re-resection, when she had a recurrence in the left thoracic cavity and dissemination in the peritoneal cavity. She died of the recurrence 15 months after the re-resection and 34 months after the prior thoracotomy.     

Immunohistochemistry and surgical approaches in solitary fibrous tumor of the pleura

Solitary fibrous tumor of the pleura (SFTP) is a rare, benign, slow-growing neoplasm that arises from the submesothelial cells of the pleura. Usually, resection of the tumor and adjacent structures are sufficient for resolution. Nowadays, videothoracoscopy (VTC) allows adequate access for the surgical treatment of these tumors. CD34 antigen positivity is a differential feature with mesothelioma. We present our experience with 15 patients with SFTP (nine women and six men) who underwent surgical resection in the last 12 years (10 thoracotomies, one sternotomy and four VTC). Only four patients were symptomatic at diagnosis. In our opinion, VTC is a less invasive diagnostic and therapeutic approach than thoracotomy that provides an adequate approach for the resection of SFTP in selected patients. Because of the malignant potential of this tumor, long-term follow-up is mandatory.