纵隔良性畸胎瘤的诊断及外科治疗特点

目的探讨纵隔良性畸胎瘤的诊断及外科治疗特点。方法对1966年～1997年收治的132例纵隔良性畸胎瘤患者的临床资料进行回顾性分析。结果本组患者的主要症状为胸痛、胸闷、气短、咳嗽及痰中带血。纵隔良性畸胎瘤术前易误诊为胸腺瘤及肺癌等。本组术前误诊率高达31．1％（41／132）。影像学检查肿瘤位于后纵隔1例，位于前纵隔131例。43例胸片或胸部CT有肿瘤钙化。所有患者均行肿瘤切除，根治性切除率88．6％（117／132），其中16例同时行肺切除，10例行部分心包切除，17例损伤血管并予以修补。手术并发症发生率22．0％（29／132），无手术死亡。结论纵隔良性畸胎瘤易被误诊。前纵隔肿物在CT检查表现有囊性、厚壁、钙化及脂肪密度等特点时应首先考虑良性畸胎瘤可能。外科手术时应注意切口选择及避免损伤血管、神经。

Diagnosis and Surgical Treatment of Mediastinal Benign Teratomas

Objective To study the diagnosis and surgical treatment of mediastinal benign teratoma.Methods The clinical data of 132 patients with mediastinal benign teratoma treated in our department from 1966 to 1997 were analyzed retrospectively.Results The most common symptoms included chest pain,chest distress,dyspnea,cough and hemoptysis.31.1%(41/132) of patients were misdiagnosed before operation.Routine chest radiography showed most of the tumor were located in the anterior region of mediastinum except one in the posterior region.43 patients presented with tumor calcification on chest roentgenogram or CT scan.All patients underwent tumor resection with a radical resection rate of 88.6%(117/132).Also,partial lung resection,lobectomy or pneumonectomy were performed in 16 cases,partial resection of pericardium in 10 cases,and blood vessels repair in 17 cases.The morbidity rate was 22.0%(29/132) with no operation-related death.Conclusion Mediastinal benign teratoma is easily misdiagnosed.When CT scan demonstrates a thick-walled cystic mass in the anterior region of mediastinum with calcification and/or fat density,the diagnosis of mature teratoma can be made with a high degree of certainty.Attention should be paid to the incision selection and the protection of blood vessels and nerves.