纵隔囊肿的诊断及外科治疗

目的总结纵隔囊肿的疾病分类、临床特点及外科治疗方法。方法回顾性分析1993年1月-2006年7月经手术病理证实的122例纵隔囊肿病例的临床资料。其中51例有临床症状，71例无临床症状。MRI术前诊断准确率为78．0％，较CT的38．2％高。结果囊肿位于前上纵隔53例，中纵隔34例，后纵隔35例。完整切除103例，大部切除19例。病理证实支气管源性囊肿42例，食管及胃肠源性囊肿9例，胸腺囊肿31例，心包囊肿19例，其他囊肿21例。2001年以后的64例病例中常规手术35例，微创手术29例，微创手术患者较常规手术患者术后住院时间短。结论纵隔囊肿以前肠囊肿最常见，术前诊断率低。胸腔镜等微创手术是治疗中、后纵隔囊肿的优先选择。

Diagnosis and surgical treatment of mediastinal cyst

Objective To summarize the spectrum, clinical feature and surgical treatment of mediastinal cyst. Methods One hundred and twenty-two cases of mediastinal cyst confirmed by pathologic examination between January 1993 and July 2006 were retrospectively analyzed. In the series,71 cases were asymptomatic, and others had symptoms such as chest pain, dyspnea, cough and so on. MRI contributed to more correct diagnosis of cyst than CT before operation. All cases received surgical treatment and pathologic examination. Results Fifty-three cysts were located in the anterosuperior mediastinum, 34 in the middle mediastinum and 35 in the posterior mediastinum. One hundred and three cysts were resected completely and 19 cysts were reseeted subtotally. According to pathologic examination,42 corresponded to bronchogenic cysts ,9 esophageal and enterogenous cysts,31 thymic cysts, 19 pericardial cysts, and 21 other cysts. Thirty-five of all 64 cases in the latest five years received conventional surgery and other 29 received minimal invasive surgery. Hospital stay of minimal invasive surgery was shorter than that of conventional surgery. Conclusions Foregut cyst is the most common type of mediastinal cyst. Over half of mediastinal cysts are asymptomatic. Mediastinal cysts are rarely diagnosed before operation. Minimal invasive surgery such as video-assisted thoracoscopic surgery is the prior choice for cysts located in the middle and posterior mediastinum.