原发性纵隔肿瘤的外科治疗

目的总结原发性纵隔肿瘤的外科治疗经验。方法回顾性分析我院1986年6月~2004年12月122例原发性纵隔肿瘤患者的临床资料,肿瘤全部切除107例,肿瘤大部分切除6例,单纯探查活检9例,手术切除率为92.6%(113/122)。结果手术死亡2例,术后94例患者获得随访,随访3个月~18年。除1例良性胸腺瘤切除术后7个月肿瘤复发外,其余良性纵隔肿瘤患者术后均预后良好。2例年轻的胸腺癌患者分别在术后3个月和5个月死于癌肿复发及其引起的各种并发症。结论原发性纵隔肿瘤不论良性还是恶性,只要无明确的远处转移和呼吸循环系统功能不全,允许胸部探查者均应及早手术,争取摘除肿瘤。     

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。     

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...     

原发性附睾肿瘤的诊断和治疗(附16例报告)

目的探讨原发性附睾肿瘤的临床特点,提高诊断和治疗水平。方法回顾性总结16例接受手术治疗的原发性附睾肿瘤患者的临床资料,其中13例为附睾良性肿瘤,包括附睾腺瘤样瘤7例,附睾平滑肌瘤3例,附睾纤维假瘤1例,附睾乳头状囊腺瘤1例,附睾硬化性血管瘤1例。13例附睾良性肿瘤患者中8例行肿瘤切除,5例行附睾切除。附睾恶性肿瘤3例,其中腺癌2例,非霍奇金淋巴瘤1例,均行睾丸附睾切除加腹膜后淋巴结清扫。结果良性肿瘤12例获随访,至今无一例复发;恶性肿瘤均获随访,预后差,2例附睾腺癌术后9个月均死亡,1例非霍奇金淋巴瘤术后2年死亡。结论附睾肿瘤大部分是良性肿瘤,手术效果好。附睾恶性肿瘤少见,但预后差。手术是治疗附睾肿瘤的首选方法 。     

13例非粘液性心脏肿瘤的外科治疗

目的 总结非粘液性心脏肿瘤外科治疗的经验。方法 13例非粘液性心脏肿瘤中，良性肿瘤5例，原发性恶性肿瘤7例，转移性恶性肿瘤1例。5例良性肿瘤均完整切除；7例原发性恶性肿瘤中2例完整切除，2例大部分切除，3例仅做部分切除；1例转移性恶性肿瘤完整切除。结果 全组无围手术期死亡。5例心脏良性肿瘤中，1例纤维瘤患者术后6个月肿瘤复发，未再行手术治疗；其余4例患者随访3个月至11年，未见肿瘤复发。3例手术完整切除的心脏恶性肿瘤患者，其中1例随访4个月肿瘤无复发，1例术后1年死于肿瘤复发，1例恶性转移癌患者术后8个月死于多器官功能衰竭。5例行肿瘤部分切除的心脏恶性肿瘤患者，其中3例分别于术后3、6和14个月死于肿瘤复发。结论 心脏良性肿瘤手术治疗效果好，应争取彻底切除肿瘤，防止复发；心脏恶性肿瘤预后欠佳，手术目的应以明确诊断、消除或减轻临床症状为主。     

老年性巨大纵隔肿瘤的手术治疗

目的总结老年性巨大纵隔肿瘤的手术治疗效果。方法回顾性分析2008年1月至2013年5月扬州大学临床医学院苏北人民医院12例年龄大于60岁行巨大纵隔肿瘤手术治疗的老年患者,男7例、女5例,年龄60~71(64.2±3.4)岁。手术全部切除11例,姑息性切除1例,其中肺叶切除2例,部分心包切除2例。结果全组无手术死亡病例。术后病理诊断:脂肪瘤1例,胸骨后甲状腺瘤2例,纵隔囊肿3例,胸腺瘤2例,神经鞘瘤1例,腺鳞癌1例,鳞癌1例,孤立性纤维性肿瘤1例。术中并发大出血1例,术后并发复张性肺水肿2例,予以对症治疗后痊愈。随访3个月至5年,1例失访。1例因肿瘤转移死亡,1例死于其它疾病;余9例随访均健康,生活质量良好。结论手术治疗老年性巨大纵隔肿瘤效果好。术前应充分做好准备,术中防止低血压、心脏压迫,控制致命性出血,术后积极防治复张性肺水肿。     

原发性腹膜后巨大肿瘤的手术经验

目的总结原发性腹膜后巨大肿瘤的外科手术经验。方法回顾性分析1998~2002年18例腹膜后巨大肿瘤手术治疗的临床资料。结果14例完整切除,1例大部切除,3例剖腹探查加活检术。14例恶性肿瘤中有10例完整切除,其中8例行联合脏器切除;4例良性肿瘤均完整切除,其中1例行联合脏器切除,无手术死亡。随访3年,18例中14例健在,死亡4例,肿瘤复发14例。结论准确的术前评估、恰当的手术径路、良好的手术技能是提高手术切除率的关键。     

原发性肝脏神经内分泌肿瘤的诊断与手术切除治疗

目的 探讨肝脏原发性神经内分泌肿瘤(primary hepatic neuroendocrine neoplasm,PHNEN)诊断和手术切除疗效.方法 回顾分析2006年8月至2014年6月本组手术治疗18例PHNEN临床资料,采用Kaplan-Meier方法进行术后生存分析.结果 本组无手术死亡,术后全部获得随访,平均随访时间42.7个月,术后生存时间8～89个月,死亡4例,总生存时间分别为8、15、18、59个月.术后1、3、5年累计复发率分别为16.7％、50.0％、70.0％,1、3、5年实际累计生存率分别为94.4％、75.0％、50.0％.是否根治性切除与肿瘤细胞增殖活性分级是影响PHNEN手术预后的因素.结论 PHNEN恶性程度较低,明确诊断需依据病理学检查,根治性手术切除、增殖活性分级G1和G2型肿瘤预后较好.     

电视胸腔镜治疗原发性纵隔肿瘤30例临床体会

目的探讨电视胸腔镜原发性纵隔肿瘤切除术的临床疗效。方法对30例原发性纵隔肿瘤患者实施电视胸腔镜手术切除。结果 30例患者均成功完成手术。手术时间为(84.66±39.84)min,术中出血量为(120.50±47.08)m L。术后胸腔引流时间为(5.68±1.12)d。术后住院时间为(6.49±1.60)d。未发生肺不张、肺部感染、出血等并发症。随访8~24个月,无复发病例。其中1例合并重症肌无力的患者出院后仍需服用口服药物改善症状。结论电视胸腔镜原发性纵隔肿瘤切除手术具有创伤小、恢复时间短、安全性高等优点,但应严格掌握手术适应证。     

原发性腹膜后肿瘤诊治的回顾性分析

目的 分析并总结原发性腹膜后肿瘤的诊断及治疗经验.方法 回顾性分析1996年1月至2013年5月收治的147例原发性腹膜后肿瘤患者的临床资料及随访结果.结果 147例中,良性肿瘤49例,完整切除40例,部分切除9例;复发5例,均再次手术.恶性肿瘤98例,完整切除32例,部分切除60例,仅行手术活检6例;复发20例,再次手术13例.随访时间0.5～17年,良性肿瘤死于其他疾病8例,死于原发性腹膜后肿瘤1例;恶性肿瘤死亡73例,其中1年内死亡26例,3年内死亡40例,5年内死亡7例.结论 B超、CT及MRI检查是目前诊断原发性腹膜后肿瘤方便、有效的诊断手段,手术治疗是原发性腹膜后肿瘤的首选治疗方式,完整切除肿瘤是影响原发性腹膜后肿瘤治疗效果及其预后的重要因素.对于复发病例应选择再次手术治疗.     

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。     

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。     

多学科合作外科处理头颈部复杂肿瘤

目的：探讨多学科合作外科处理头颈部复杂肿瘤的经验,以提高临床治疗效果。方法：回顾分析1995年4月－2000年6月与神经外科等其他学科合作,外科治疗头颈肿瘤累及颅底,颅内或颈椎管内等相邻部位结构的22例患者临床资料。结果：本组良性肿瘤患者14例,获得肿瘤全切除;恶性肿瘤8例,5例达到肉眼全切除,3例得到减状治疗,无手术死亡和严重并发症病例,良性肿瘤患者平均随诊3例,肿瘤复发率为21．4％（3／14）,均为外院术后再治疗,8例恶性肿瘤患者随诊1年,3例无复发,2例带瘤生存,3例死亡。结论：对于复杂的头颈部肿瘤的外科治疗,应提倡多学科间的密切合作,可明显提高患者的治疗效果。     

22例原发性气管肿瘤的诊断与外科治疗

目的总结22例原发性气管肿瘤手术治疗的临床经验,以提高手术疗效。方法22例原发性气管肿瘤患者,其中良性肿瘤4例,恶性肿瘤18例。行气管对端吻合14例,隆凸重建4例,纤维支气管镜下摘除肿瘤1例,局部搔刮2例,气管修补1例。气管切除长度2．0～5．2cm,平均3．8cm。结果22例中确诊前有17例在门诊误诊,误诊率77．3％,大多数患者被误诊为支气管哮喘。术后30d内死亡1例,死于急性呼吸衰竭。发生并发症7例（31．8％）,分别为肺部感染4例,吻合口瘘1例,乳糜胸2例;远期并发症吻合口狭窄3例,经再次手术治疗,狭窄改善。随访20例,随访时间1个月～8年。4例良性肿瘤患者在随访期间均无瘤生存;16例恶性肿瘤患者术后随访满5年以上生存6例,因肿瘤脑、肝和骨远处转移死亡3例。结论手术切除是治疗气管肿瘤最有效的方法,气管节段切除是治疗气管恶性肿瘤的主要术式,良性肿瘤可以考虑保守术式,降低手术并发症是取得良好手术疗效的关键,掌握气管肿瘤的临床特点、提高对该病的认识是减少误诊的有效手段。     

Surgical treatment of neurogenic tumors of the chest.

BACKGROUND: Neurogenic tumors are commonly found in the mediastinum, especially in the posterior mediastinum or in the chest wall, and have a variety of clinical and histological features. We reviewed our experience with these types of tumors and assessed diagnostic and therapeutic approaches. PATIENTS AND METHODS: A series of 60 consecutive patients with a neurogenic tumor of the chest, all seen at a single institute, was retrospectively reviewed. RESULTS: The mean age of the 60 patients was 40 years, including 32 males and 28 females. Preoperative symptoms were present in seven patients (11.7%). Median tumor size was 5.3 cm, ranging from 1.4 to 20 cm. The major location of the tumor was the posterior mediastinum in 38 cases (63.3%) and the chest wall in 16 cases (26.7%). The operative procedure performed was tumor extirpation in 58 cases (96.7%), in which video-thoracoscopic procedure was performed in nine patients and chest wall resection in two cases. The major histological type was neurilemmoma in 51 patients (85%), and malignant tumor was only diagnosed in one patient with malignant schwannoma. Tumor related death occurred in only one case with malignant schwannoma. Ten patients with neurilemmoma were precisely diagnosed by magnetic resonance imaging. CONCLUSION: Almost all cases of intrathoracic neurogenic tumors were benign in nature. Therefore, surgical indications may be carefully determined in cases with no symptom and with imaging that indicate benign neurilemmoma.     

Esophageal resection for giant leiomyoma: report of two cases and a review of the literature

Introduction  Big masses of the mediastinum causing dysphagia are both a diagnostic and a therapeutic challenge for gastroenterologists and surgeons. Besides of hernia and cysts, lymphomas, neurogenic as well as benign or malignant mesenchymal tumors are potential diagnoses. Since biopsies are often not conclusive, mostly the diagnosis can only be secured postoperatively. Case reports  In this article, we report on two cases of giant esophageal leiomyoma, in which radical surgical resection was performed for the relief of symptoms and to secure diagnosis accurately. The specimen revealed tumors of 750 and 550 g, respectively. Only histological and immunohistochemical examination could rule out malignant low grade leiomyosarcoma. Conclusion  Esophageal leiomyomas are approximately 50 times less common than carcinoma, but they are the most common benign tumors of the esophagus. Whereas removal of the tumor by enucleation by conventional thoracotomy or thoracoscopy can be performed in most cases, esophagectomy is required for giant tumors of the esophagus.     

Primary cardiac valve tumors: early and late results of surgical treatment in 10 patients

BACKGROUND: Our goal was to study the clinical characteristics of primary valve tumors and the late surgical results of their resection. METHODS: We reviewed our clinical experience with the surgical treatment of ten primary valve tumors at Fu Wai Hospital over the past 19 years. During that time, cardiac valve tumors accounted for 2.65% of all primary cardiac tumors at our hospital, and the incidence of primary valve tumors was roughly one in 4,000 cardiac operations. There were 5 male and 5 female patients aged 2 to 66 years (mean age, 30.1 years). The clinical presentation included exertional dyspnea in 7 patients, neurological symptoms in 2, and cyanosis at rest in 1 patient. The diagnosis was established by preoperative echocardiography in 8 patients, and in the other 2, it was confirmed by the findings at operation. All of the tumors were resected. Eight of the ten tumors were benign, and two were malignant. RESULTS: All patients survived the operation and recovered uneventfully. Late outcomes were known for all patients. There were three late deaths. One patient with a benign tricuspid valve tumor died 2 months postoperatively of an electrolyte disorder. The other 2 patients with a malignant mitral valve tumor died within 1 year postoperatively. The 7 survivors, all with a benign valve tumor, were followed for an average of 5.7 years (range, 8 months to 19 years), and all were in functional class I. Exercise tolerance improved to normal levels. The latest follow-up echocardiograms showed no evidence of local recurrence in any patient. CONCLUSIONS: Excellent early and late surgical results can be obtained in patients with benign valve tumors. The prognosis for patients with a malignant valve tumor is poor.     

颈胸段脊柱肿瘤的外科治疗

目的 观察比较不同手术入路方法治疗颈胸段脊柱肿瘤的疗效。方法 本组９例,共１０例次。对其中４例肿瘤同时累及椎体及椎体后部结构的患者,选择前后路同期手术,经前路切除肿瘤、椎管减压及钢筋骨水泥或前路钢板固定,并同期行后路肿瘤切除术,其中１例行Ｌａｕｑｕｅ棒固定;对４例肿瘤仅累及椎体者,选择经前路切除肿瘤、椎管减压、钢筋骨水泥固定;另２例肿瘤单纯累及椎体后部结构者,经后路行肿瘤切除和椎管减压术。术后４例     

颅鼻沟通性肿瘤一期联合手术及颅底重建的早期疗效

目的探讨颅鼻沟通性肿瘤的联合手术及颅底重建方法。方法2005年6月-2007年10月,收治颅鼻沟通性肿瘤20例。其中男10例,女10例：年龄13～77岁,中位年龄49岁。病程2个月～13年。临床表现：嗅觉减退14例,头痛11例,鼻塞9例,鼻衄8例,视力障碍4例,突眼4例,伴意识障碍2例。术前CT及MRI检查均示前颅窝底占位,向下侵及鼻窦、鼻腔,形成颅腔、鼻腔沟通,部分肿瘤突入眶内。CT骨窗示病变均伴不同程度筛板及周围骨质破坏。采用额下入路联合经鼻入路一期手术切除肿瘤,并采用带蒂骨膜瓣或“下拉式三明治”法行颅底重建。结果病理检查示恶性肿瘤8例,良性肿瘤12例。术后均恢复良好,无手术死亡。2例患者术后发生一过性脑脊液鼻漏,经腰穿持续引流治愈;无脑／脑膜膨出发生。18例获随访3个月～2年6个月。1例副鼻窦来源的神经内分泌癌术后3个月肿瘤复发,衰竭死亡;1例嗅母细胞瘤于术后15个月复发,另1例嗅母细胞瘤术后2年复发,未再治疗,死于颅内高压;1例鳞状细胞癌术后2年死于肿瘤广泛转移;1例粘液瘤术后半年残瘤增大。其余13例随访期内未见复发,均恢复正常生活或工作。结论额下入路联合经鼻入路能够一期手术全切颅鼻沟通性肿瘤,早期效果好;用带蒂的颅骨骨膜瓣修补颅底或用“下拉式三明治”法行颅底重建,取材简便,安全有效,并发症发生率低。     

Hepatobiliary cystadenoma with mesenchymal stroma.

In a detailed review of cystic hepatobiliary neoplasms, we identified a subset of 50 cases in which tumors were characterized by the presence of a mesenchymal cell layer interposed between an inner epithelial lining and an outer connective tissue layer. We have recently seen three such patients, making a total of 53 patients reported in the English literature. All of the patients were female, 44 of whom, with an average age of 41 years, had benign tumors. The average age of the remaining nine patients was 57 years and these patients had malignant tumors. In seven patients, the malignancy arose from the epithelial layer, but in two patients sarcomatous changes were identified in the mesenchymal tissues. The older age of the patients with malignant tumors with adequate serial biopsies in two cases supported the thesis that malignant transformation may occur in the benign tumors. Moreover the location of the tumor in one of our patients in whom the resected tumor was associated with anomalous right hepatic ducts and portal veins supported the theory that these tumors develop embryologically from nests of primitive hepatobiliary endodermal and mesodermal cells. Although surgical treatment was performed in all patients, 25% of the patients with benign hepatobiliary cystadenoma with mesenchymal stroma (CMS), and 33% of the patients with malignant CMS had tumor recurrence after primary resection. Ninety per cent of these patients had an incomplete resection at the time of their initial operations. Forty-four per cent of the patients with malignant CMS died after a mean follow-up of 17 months. We conclude that CMS (Edmonson's tumor) occurs uniquely in young female patients, develops from nests of primitive embryonal cells, has the potential for malignant transformation, and should be completely resected at primary operation to avoid recurrence.