巨大纵隔肿瘤术中特殊处理

 目的 探讨巨大纵隔肿瘤术中特殊疑难问题的处理经验。方法 回顾分析1982年1月-2004年6月36例巨大纵隔肿瘤的临床资料，良性肿瘤30例，恶性肿瘤6例。36例均有肺功能障碍，心电图异常18例、声音嘶哑6例、上腔静脉梗阻9例。采用完整、分块、大部切除法完整切除肿瘤28例，大部切除肿瘤8例；单纯肿瘤切除19例，联合上腔静脉、无名静脉成形术5例，部分左心房切除2例，肺切除17例。切除肿瘤重828-4264g，平均2673g，术中出血400-4900mL。结果 全组无手术死亡。术后并发呼吸衰竭2例、二次开胸止血1例、采用预防复发性肺水肿措施后并发肺水肿1例，均治愈出院。结论 手术切口尽量靠近瘤体、又便于伸延，充分显露术野、采用完整、分块、大部切除等手术技巧和处理大血管、重要脏器经验，术中尽旱应用预防复发性肺水肿措施是手术成功的关键。

Special Treatment of Giant Mediastinal Tumor Interoperation

Objective To study the special treatment experience for giant mediastinal tumor interoperation. Methods Data of 36 giant mediastinal tumor cases hospitalized from January, 1982 to June, 2004 was analyzed retrospectively. 30 cases were benign tumor and 6 cases were malignant tumor. 36 cases with pulmonary disorders, 18 cases with abnormal electrocardiograph, 6 cases with dumbness, 9 cases with superior vena obstruction were found. Redieal excision was performed in 28 patients, palliative excision in 8 cases, tumor of 17 cases had been successfully removed with parts of eava superior vein or anonyma vein or atrium sinistrum or pulmo, the average weight of the tumors was 2 673 gram. Bleeding ranged from 400~4 900ml. Results There was no perioperative death occurred, 2 cases of respiratory failure, 1 cases of surgical stop bleeding, 1 cases of dilatant pneumoedema after taking measure postoperatively, all patients were cured. Conclusion The key managrnent is proper surgical route, full appearance , good operating skill and experience and taking early preventive measure for dilatant pneumoedema.