侵及胸廓上口大血管的纵隔肿瘤的外科治疗

目的　探讨侵及胸廓上口大血管的纵隔肿瘤的外科治疗经验。方法　回顾分析 11例侵及胸廓上口大血管的纵隔肿瘤患者的临床资料 ,全组患者均行纵隔肿瘤切除 ,其中 2例于麻醉诱导前辅以股 -股转流并行体外循环 ,2例辅以颈静脉、股静脉 -股动脉转流并行体外循环。同期行上腔静脉重建 2例 ,成形 2例 ,左无名静脉成形 3例 ,右无名静脉成形 1例 ,无名动脉、左颈总动脉、左锁骨下动脉人造血管置换各 1例。结果　全组病例无手术死亡。术后随访 2～ 7年 ,3例于 2～ 4年后死于癌瘤复发 ,6例无瘤健康生存 ,均未出现血管栓塞。结论　侵及胸廓上口的大血管纵隔肿瘤宜积极手术治疗 ,麻醉诱导前辅以股 -股转流或颈、股 -股转流。同期作血管成形或重建。术后小剂量抗凝治疗

Surgical treatment for giant solid mediastinal tumors invading great vessels of the thoracic outlet

Objective To investigate the experience of the surgical treatment for giant solid mediastinal tumors invading great vessels of the thoracic outlet.Methods 11 patients with mediastinal tumors invading great vessels of the thoracic outlet were treated surgically from 1994 to 2001.Resection of the tumors were accomplished in all patients.Femorofemoral cardiopulmonary bypass or Cervical-Femorofemoral cardiopulmonary bypass were used to support induction of anesthesia in 4 cases.Reconstruction of the superior vena cave and the innominate vein were accomplished both in 4 cases.Reconstruction of the innominate artery,left common carotid artery,left subclavian artery were accomplished with vascular prosthesis,each in 3 cases.Results All patients recovered without perioperative death.No thrombosis occured in all patients.Conclusion Femorofemoral cardiopulmonary bypass was useful prior to induction of anesthesia for patients with superior airway obstruction.When major vessels were invaded,vascular reconstruction should be performed.