纵隔神经源性肿瘤临床病理特征和外科治疗

目的　探讨原发性纵隔神经源性肿瘤的临床病理特征和外科治疗原则。方法　总结125 例纵隔神经源性肿瘤的诊治经验。所有病例均经手术和病理证实。结果　神经源性肿瘤占同期原发性纵隔肿瘤及囊肿的22 .0 % (125/568) 。其中神经鞘瘤48 .9 % (61/125) ,神经纤维瘤27 .2 % (34/125) ,节细胞神经瘤13 .6 % (17/125) ,其他少见肿瘤10 .4 % (13/125) 。无临床症状而于查体时发现78例,占62 .4 % 。肿瘤位于后纵隔117 例。手术切除率98 .4 % (123/125) ,术后并发症发生率4 .0 % (5/125) ,手术死亡率0 .8 % 。恶性肿瘤的3 年生存率18 .2 % 。结论　纵隔神经源性肿瘤的临床特征与病理类型相关,无论良恶性均首选手术治疗,不同的病理类型有不同的预后。

Clinicopathological characteristics and surgical treatment of primary neurogenic tumors of the mediastinum

Objective To study the clinical and histopathological characteristics, and surgical treatment of primary neurogenic tumors of the mediastinum.Methods The experience in diagnosis and treatment of 125 patients with primary neurogenic tumors of the mediastinum from Jan. 1965 to Dec. 1998 in our hospital was summarized. All patients were operated and pathologically confirmed. Results Primary neurogenic tumor accounted for 125(22.0%) of 568 patients with primary tumors of the mediastinum in the same period. The incidence of neurilemoma was 48.9% (61/125), neurofibroma 27.2% (34/125), ganglioneuroma 13.6% (17/125), and other rare tumors 10.4% (13/125, neurofibrosarcoma 4, ganglioneuroblastoma 3, chemodectoma 3, pheochromocytoma 2, and neuroblastoma 1). In this series, 78 patients did not have any subjective symptoms, and the tumors were found on routine physical checkup. In 117 patients, the tumors were located in the posterior mediastinum. In all bwt 2 patients, the tumor was resectable. The postoperative complication rate was 4.0% and operative mortality rate was 0.8%. The 3 year survival rate in patients with malignant tumors was 18.2%. Conclusion The clinical characteristics and prognosis of primary neurogenic mediastinal tumors varies with their histopathology. Surgical operation is the first choice of treatment.