Surgical treatment of malignant mediastinal neurogenic tumors in children.

INTRODUCTION: The aim of this study was to identify the role of surgical resection in the treatment of malignant mediastinal neurogenic tumors in children. MATERIALS AND METHODS: Thirty-eight consecutive children, who underwent surgical resection of a malignant mediastinal neurogenic tumor between 1986 and 2004, were included in this study. The tumor cell types were neuroblastoma in 23 patients (60.5%), ganglioneuroblastoma in 14 (36.8%), and malignant neuroepithelioma in 1 (2.6%). Surgery was performed for curative resection in localized tumors and salvage resection of residual mediastinal masses after chemotherapy in stage IV tumors. Of the 16 patients (42.1%) who underwent salvage resection, 14 had neuroblastoma and 2 ganglioneuroblastoma. RESULTS: Mean patient age was 3.4+/-3.0 years (1 month-13 years) and 26 patients (68.4%) were symptomatic at presentation. Adjacent structure invasion was found in eight patients (21.1%), invasion of chest wall in four, heart and vena cava in two, lung in one, and chest wall and lung in one. Complete gross resection was possible in 30 patients (78.9%) and there was no surgical mortality. Surgical morbidity occurred in 10 patients (26.3%) and Horner's syndrome was the most frequent complication (n=7). The 5-year survival was 95.2% for a localized tumor and 52.5% for a stage IV tumor (p=0.004). The significant risk factors of long-term survival were adjacent structure invasion (p=0.002) and a stage IV tumor (p=0.002) by multivariate Cox regression analysis. CONCLUSIONS: Surgical resection of localized malignant mediastinal neurogenic tumor in children showed good long-term survival, and salvage operations after chemotherapy showed acceptable long-term survival.     

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。     

骶椎神经源性肿瘤的外科治疗

目的:观察Ⅰ期肿瘤切除手术治疗骶椎神经源性肿瘤的疗效及并发症,探讨手术相关的解剖学原理。方法:对2001年1月至2018年1月手术治疗的26例骶椎神经源性肿瘤患者进行回顾性分析,男16例,女10例;年龄21~69(39.3±10.9)岁;病程3~56(17.9±10.1)个月;骶前肿块直径3.3~19.6(8.7±4.1) cm;骶前肿块上缘高于和不高于L₅S₁间隙水平者分别为6和20例。手术均先取后入路,必要时附加前入路,Ⅰ期切除肿瘤,部分患者行腰椎-骨盆内固定重建,术中视情况决定是否保留载瘤神经根。记录患者的手术时间、术中出血量、疼痛缓解程度及并发症情况。术后随访评估腰骶椎稳定性和神经功能,并检查有无局部复发和远处转移。结果:26例均Ⅰ期完整切除肿瘤,手术时间(160.4±35.3) min,术中出血量(1 092.3±568.8) ml。单纯后入路21例,前后联合入路5例。前后联合入路者骶前肿块直径11.3~19.6(15.1±3.2) cm,单纯后入路者为3.3~10.9(7.2±2.4) cm。骶前肿块上缘高于L₅S₁间隙的6例患者中5例采取了前后联合入路,不超过L₅S₁间隙的20例均为单纯后入路。所有病例获得随访,时间6~82(45.4±18.2)个月。术后腰骶痛、下肢根性痛均明显缓解,感觉、肌力和二便功能也有不同程度改善。术后切口浅表感染1例,脑脊液漏2例。病理证实神经鞘瘤17例,神经纤维瘤7例,恶性神经鞘瘤2例。2例良性神经源性肿瘤局部复发,1例恶性神经鞘瘤术后20个月时死于肺转移。17例高位骶骨神经源性肿瘤有4例未行内固定重建,其中2例术后脊柱失稳。7例切除载瘤神经根,其中1例同时切除S₂和S₃神经根的患者术后出现膀胱和直肠功能异常,且未能完全恢复,另6例神经功能无明显损害或恢复良好。结论:后入路能直接显露病灶,处理神经根和血管也方便,手术时间、术中出血量、症状缓解程度、并发症率和复发转移率均能控制在适当水平,是安全有效的手术入路;但当骶前肿块上缘高于L₅S₁水平或骶前肿块直径达到10 cm以上时,应考虑附加前方入路。脊柱和骨盆之间应力较高,高位骶椎神经源性肿瘤切除术中应使用内固定重建脊柱-骨盆的力学连续性。载瘤神经根多已丧失功能,切除单根载瘤神经根不易引起严重神经功能障碍,而邻近神经根具有代偿功能,术中应尽量保留。     

Surgical therapy of chest wall tumors

Tumors of the chest wall may occur as both primary and secondary tumors. Diagnosis is established by clinical examination, conventional and/or computed tomography. In most cases of chest wall tumors resection is the treatment of choice. It should be performed with a safe distance to the tumor, if necessary with bloc resection of another intrathoracic part or adjacent tissues. For skeletal reconstruction non-absorbable and absorbable mesh is available; even complete replacement of the sternum is possible. Large full thickness defects can be covered with sliding flaps or myocutaneous flaps from adjacent locations.     

Surgical management of chest wall tumors

A new technique for reconstruction of the chest wall providing immediate chest wall stability was employed in six patients who required extensive chest wall resection for a variety of neoplasms. Despite preoperative impairment of pulmonary function, early extubation was possible in all patients. Pulmonary function was well preserved on follow-up examination.     

Surgical management of chest wall tumors]

Twenty-four patients with chest wall tumors underwent resection during the past twenty years. There were 12 female and 12 male patients with ages ranging from 7 months to 78 years (mean 44 years). Five patients had primary malignant neoplasms, 7 had metastases, and 12 had benign tumors. The tumor was located in the soft tissue in 14 patients and in the ribs and the sternum in 10. Ninety-two percent of tumors were diagnosed correctly if they were benign or malignant before resection, however the final diagnosis was made in only 25% of benign tumors and 54% of malignant tumors before surgery. Thirty-one operations were performed in 24 patients and 10 reconstruction with prosthetic materials were done. Concerning malignant neoplasms patients with primary tumors had better prognosis than those with metastases and patients underwent reconstruction had better prognosis than those underwent resection only. We conclude that wide resection with reconstruction is potentially curative treatment.     

33例漏斗胸与扁平胸的外科治疗

目的 总结漏斗胸及扁平胸施行腹直肌蒂胸骨翻转术（ＳＴＯ－ＲＭＰ）及胸骨重叠术的治疗经验和体会。方法 １９８３年９月至１９９７年７月为３３例漏斗胸病人施行ＳＴＯ－ＲＭＰ,并对７例同时伴扁平胸的病人施行胸骨重叠术。年龄２．５－３４岁（中位数６．０岁）,漏斗胸指数（Ｆ２Ｉ）０．２７－０．７７（中位数值０．３３）;非对称性漏斗胸者１１例,伴其它部位先天畸形者９例。     

Surgical treatment of neuroendocrine tumors of the lung.

OBJECTIVE: This report reviews the pattern of neuroendocrine (NE) differentiation, lymph-node involvement, extension of surgery, and survival in 125 NE lung tumor patients. METHODS: Standard diagnostic workup included CT scan, bronchoscopy, bronchial biopsy or Fine Needle Aspiration Biopsy, (111)In-pentetreotide scan (OctreoScan) and mediastinoscopy in selected patients. NE differentiation was assessed based on the morphology and immunohistochemical reactivity for pan-neuroendocrine markers NSE, CGA, and Synaptophysin. For small cell carcinoma (SCC), only clinical stage I and II patients underwent surgery. Several different surgical procedures were utilized, from limited resections to lobectomy, pneumonectomy, and bronchoplastic procedures. Survival was assessed using Kaplan-Meyer method at 5 years. RESULTS: There were 79 typical carcinoid (TC), eight atypical carcinoid (AC), 18 large cell carcinoma (LCC) and 20 SCC patients. Mean age at diagnosis was 54.6+/-15.2 (ranges from 16 to 77 years) for TC, 68.5+/-9.1 (range 53-81) for AC, 68.7+/-4.6 (range 58-77) for LCC, 64.6+/-7.9 (range 48-82) for SCC. Male/female ratio was 1/1 for TC and AC, 2.6/1 for LCC and 9/1 for SCC. Lymph-node involvement was present in 14% of TC, 0% of AC, 31.5% of LCC, and 45% of SCC. Cancer specific survival was 96% for TC, 87.5% for AC, 37.5% for LCC, and 30% for SCC at 5 years from surgery. Presenting symptoms were invariably of respiratory-related. None had the carcinoid syndrome. History of tobacco abuse ranged from 46% for TC to 100% in SCC. Survival ranged from a minimum of 1 month for SCC to a maximum of 168 months with no evidence of disease for TC. Synchronous multicentric forms were found in 14% of TC. Twenty-one percent (4/19) of the patients with SCC treated by induction therapy and surgery, and in few cases by surgery and adjuvant chemotherapy are alive without the evidence of the disease for 5 years. CONCLUSIONS: Due to the high percentage of lymph-node involvement and multicentric forms found in our series lobectomy with radical lymph-node dissection appears, in our opinion, the most appropriate surgical treatment in well-differentiated forms, while more limited resection appears sub-optimal. Also, due to the finding of recurrences many years after surgery, the follow-up must be accurate and protracted in this subgroup. Only Small Cell Lung Carcinoma patients in clinical stage I and II underwent surgery with good long-term results.     

Surgical treatment of giant-cell tumors of the spine.

Three cases of relatively uncommon giant-cell tumors in the third cervical and first thoracic vertebra and the sacrum were treated surgically by radical resection and reconstruction. The tumor in the third cervical vertebra was treated by incomplete excision and anterior arthrodesis at a local hospital without pre- or postoperative radiotherapy. A recurrence was noted after four months, however, and an emergency operation was performed for severe quadriplegia. After posterior decompression, the tumor was resected by the lateral approach, and an autograft was performed. The tumor in the first thoracic vertebra was removed simultaneously by the anterior, posterior, and lateral approaches, and reconstruction was performed. The sacral tumor, which was radioresistant, was totally excised, and reconstruction was performed. Using these treatments, excellent results have been recorded after follow-up intervals of 1.5, three, and six years. Because of advancements in preoperative imaging techniques and better surgical techniques, radical resection is the recommended treatment for giant-cell tumors located in the spine.     

胸壁结核的外科治疗

目的 探讨胸壁结核的临床特点及疗效。方法 回顾性分析28例胸壁结核患者的临床资料。所有患者均行病灶清除术治疗,术后抗结核治疗9—12个月。结果 所有患者均获得治愈,随访1-2年无复发。结论 胸壁结核是以胸壁冷脓肿为主要特点,其主要治疗方法是手术治疗结合术前、术后抗结核药物治疗,而手术成功的关键是彻底清除病灶,消灭死腔。     

胸部穿透伤的手术治疗

本院1993年1月至2003年1月,收治胸部穿透伤42例,均采用手术治疗.现报告如下.     

Surgical treatment of asbestos-related disease of the chest

Thoracic surgeons are asked to evaluate various diseases related to asbestos, including benign pleural plaques, malignant mesothelioma, and lung cancer. The benign localized mesothelioma is usually considered in the differential diagnosis of pleural tumors, but it is not related to asbestos exposure. Benign pleural plaques can be diagnosed by history and radiologic studies, and surgery offers no therapeutic benefit. Diffuse malignant mesothelioma is currently an incurable tumor, but pleurectomy can afford some palliation. Extrapleural pneumonectomy can be accomplished with an acceptable mortality, but long-term results do not justify its routine use. Lung cancer in those exposed to asbestos fibers is treated no differently than when it occurs in the general population.     

Surgical treatment of gunshot wounds of the chest

On the basis of their experience with the treatment of such patients the authors describe modern principles of the treatment of penetrating wounds of the breast with special reference to indications for thoracotomy, treatment of lung contusion, posttraumatic empyema of the pleura.