食管癌术后纵隔转移灶的放射治疗

目的探讨胸段食管癌根治术后纵隔转移灶放射治疗的意义和效果。方法回顾性分析76例食管癌根治术后3～18个月发生纵隔转移患者。转移灶<2cm11例，2～3?cm33例，>3cm32例。伴有颈淋巴结转移9例，伴脏器转移3例。放射治疗采用60Co常规分割照射，照射剂量10.8～75.0Gy。结果未完成治疗计划的9例患者均于照射后1年内死亡。照射剂量为50～75Gy患者1、2、3年生存率分别为75.0%（57/76）、27.6%（21/76）和9.2%（7/76）。结论食管癌根治术后发生纵隔转移进行放射治疗可以延长患者生存时间，照射剂量以组织量65～75Gy为宜。     

Real-time sonography of the mediastinum in adults: a study in 100 healthy volunteers

Summary Real-time sonography has proved to be a valuable tool in the evaluation of the mediastinum in children. In the literature there is a paucity of information on ultrasound examination of the mediastinum in adults. Using a 3.5-MHz sector scanner, we evaluated a new method for the examination of mediastinal organs in adults, which is practicable in routine as well as emergency diagnosis. The endpoints of this study were the visibility of mediastinal organs and the discomfort of the patient. In 100 healthy volunteers aged 20–40 years, the normal anatomy of the anterior and middle mediastinum was investigated. Neither the height nor the weight of the volunteers limited the examination. We found that this method causes no discomfort to the subject. Via the supra-, infra- and left parasternal approaches, anatomical structures of the mediastinum are visible in a high percentage of cases. To date, this method has proved its practicability in more than 250 patients suffering from blunt thoracic trauma, primary and metastatic tumours, and infections of the mediastinum.     

FDG-PET scan in potentially operable non-small cell lung cancer: do anatometabolic PET-CT fusion images improve the localisation of regional lymph node metastases?

Exact localisation of thoracic lymph nodes (LNs) on fluorine-18 fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) can be hampered by the paucity of anatomical landmarks. In non-small cell lung cancer (NSCLC) patients referred for locoregional LN staging, we prospectively examined to what extent localisation of LNs at PET reading could be improved by visual correlation with computed tomography (CT), or by anatometabolic PET+CT fusion images. Fifty-six patients with potentially operable NSCLC underwent CT, PET and surgical staging. Prospective reading was performed for CT, PET without CT, PET+CT visual correlation and PET+CT fusion. Reading was blinded to surgical pathology data and noted on a standard LN map. Surgical staging was available for 493 LN stations. In the evaluation per individual LN station, CT was accurate in 87%, PET in 91% and visual correlation and fusion in 93%. In the identification of the nodal stage, CT was correct in 28/56 patients (50%), PET in 37/56 (66%), visual correlation in 40/56 (71%), and fusion in 41/56 (73%). It is concluded that in the exact localisation of metastatic thoracic LNs, the accuracy of reading of PET is increased if the PET images can be visually correlated with CT images. PET+CT anatometabolic fusion images add only a marginal benefit compared with visual correlation. Received 19 May and in revised form 25 July 1998     

纵隔肿瘤的X线类别诊断问题

作者通过资料分析,指出原发性纵隔肿瘤术前X线类别确诊率低的实际情况,讨论了与提高类别确诊率有关的几个问题,提出区别畸胎类肿瘤与胸腺肿瘤的一个较简明的鉴别点,并简介了纵隔鳞状上皮癌等几例罕见的纵隔肿瘤。     

纵隔淋巴结肿大作为非小细胞肺癌N病变标记的意义

报告５６例非小细胞肺癌（ＮＳＣＬＣ）手术摘除的纵隔淋巴结标本的直接观察结果。发生淋巴结肿大（直径≥１．０ｃｍ）假定为Ｎ病变５２例（９２．９％）。其中假定Ｎ１１１例，Ｎ２４１例。经病理学检查确定为Ｎ病变１９例，包括Ｎ１３例，Ｎ２１６例。假定为Ｎ０病变４例，其中１例为真正Ｎ１病变。鳞癌患者普遍为假定的Ｎ２病变，但真正Ｎ病变发生率低（２／１６例，１１．１％），和非鳞癌患者（１４／２５例，５６％）对比，差异有非常显著性（Ｐ＜０．０１）。因此，仅根据纵隔淋巴结大小不能可靠地评估Ｎ病变和术前分期，特别是鳞癌。在发生纵隔淋巴结肿大，但未取得转移病变的组织学依据时，应争取开胸探查手术治疗。     

原发性纵隔肿瘤124例临床分析

目的:总结原发性纵隔肿瘤的诊治经验.方法:回顾性分析124例原发性纵隔肿瘤的临床资料.结果:根据病史、体格检查,结合X线胸片、胸部CT、磁共振成像等术前确诊98例(79.0%).手术治疗118例(95.2%)均获确诊,治愈110例(88 7%),死亡3例.随访期间无复发病例.结论:病史、体格检查与影像学检查相结合是原发性纵隔肿瘤的主要诊断手段;手术治疗是有效的治疗方法,尽早手术治疗效果良好.     

Tratamiento quirúrgico del bocio retroesternal: experiencia en un centro de Marruecos

Introduction and objectivesThis was a retrospective study reviewing 93 cases of retrosternal goitre (RG) operated in our department, with the aim of describing epidemiological and clinical data and discussing the surgical challenges of RG.Patients and methodsFrom January 2004 to December 2012, 35 men and 58 women presenting with RG had surgery. Eighty-nine cases (95.7%) underwent cervicotomy, and a sternotomy was mandatory in 4 cases (4.3%). Laryngoscopy was performed in all cases. A second preoperative laryngoscopy by a senior was mandatory for patients with hoarseness or dyspnea even if the initial laryngeal exam was normal.ResultsA cervical mass was noted in 81 cases (87.1%), dyspnea in 17 cases (18.3%), dysphagia in 2 cases (2.1%), hoarseness in 7 cases (7.5%), partial vena cava syndrome in 2 cases and recurrent goitre was noted in 2 cases (2.1%) after previous thyroid resection. Mediastinal extension was on the left side in 47 cases (50.5%), on the right side in 29 cases (31.2%) and bilateral in 17 cases (18.3%).A total thyroidectomy was performed in 86 cases (92.5%) and a unilateral isthmo-lobectomy was performed in 7 cases (7.5%). Mean goitre size was 9.3 cm. Postoperative complications were present in 9 cases (9.7%), 3 cases with hypoparathyroidism (3.2%) and 4 cases (4.3%) of recurrent nerve injury. There was no postoperative death. The histological study objectified 88 cases of multiheteronodular goitre, 4 cases of Basedow thyroid, and 1 case of thyroid carcinoma (papillary carcinoma).ConclusionOur experience confirms that cervicotomy often allows removing goitre with a mediastinal extension. However, intraoperative enlargement may be necessary, with increased operating time, hospital stay and morbidity.     

Ultrasonography of mediastinal teratoma

We have studied real-time sonograms of 11 surgically proven benign mediastinal teratomas. Eight cystic teratomas were sonographically visualized as various kinds of masses: four complex, two solid, and two cystic. The echo patterns of cystic teratomas were determined by the serous or nonserous nature of the cysts. In the presence of serous fluid, the tumor was visualized as a cystic mass. If, on the other hand, the cyst of the tumor was nonserous or was sebaceous, it appeared as a solid or complex tumor. The remaining three solid teratomas, which had some small cysts, appeared as complex tumors.     

纵隔良性畸胎瘤34例临床分析

自1965年至1982年手术治疗纵隔肿瘤135例,其中良性畸胎瘤34例。作者对此作了分析,并建议对畸胎瘤的诊断应统一命名,即纵隔成熟型畸胎瘤(良性)和未成熟型畸胎瘤(恶性)。本病一经诊断,主张手术治疗。随访表明效果良好。