50例胸腔巨大肿瘤的外科治疗分析

目的探讨胸腔巨大肿瘤外科手术治疗以及术中、术后特殊疑难问题的处理经验。方法回顾分析2010年1月至2013年6月在中国人民解放军总医院第一附属医院胸心外科手术治疗的50例胸腔巨大肿瘤患者的临床资料。结果完整切除肿瘤43例,大部切除肿瘤7例,单纯肿瘤切除46例,联合上腔静脉、无名静脉成形术1例,肺切除3例;正中切口纵劈胸骨8例,胸部侧切口39例,单侧胸部侧切口+横断胸骨切口1例,单侧胸部侧切口+横断锁骨切口1例,颈部横切口1例;切除肿瘤重628~2 586 g,平均1 973 g,术中出血400~1 500 ml。采用预防复张性肺水肿措施后术后并发肺水肿2例,其中1例因合并DIC死亡,1例治愈出院;其余患者术后均治愈出院。结论胸腔巨大肿瘤患者往往症状较重,内科保守治疗效果差,手术能彻底改善症状;手术切口要以接近瘤体、同时便于伸延为原则,要充分显露术野;术中可采用完整、分块、大部切除等手术技巧,注意术中避免大出血;术后尽早采用预防复发性肺水肿措施。

Surgical treatment of thoracic giant tumor: a report of 50 cases

Objective To explore the surgical treatment of thoracic giant tumor and study the special treatment experience for the interoperate and postoperative process.Methods Data of 50 thoracic giant tumor cases (26 male and 24 female)hospitalized from January 2010 to June 2013 in Department of Cardiothoracic Surgery, the First Affiliated Hospital of General Hospital of the Chinese People′s Liberation Army was analyzed retrospectively.The patients vary in age from 0.5 to 77.Results All 43 tumors were resected completely, the others were subtotal resected.The operation procedures were simple tumor resection in 46 cases, combined superior vena cava and innominate vein angioplasty in 1 case and pulmonary resection in 3 cases.Operation approaches were median longitudinal sternum incision in 8 cases, lateral thoracotomy approach in 39 cases, unilateral chest incision with transverse sternum incision in 1 case, unilateral chest incision with transverse clavicle incision in 1 case, neck transverse incision in 1 case.The weight of the tumors ranged from 628 to 2 586 gram.Bleeding ranged from 400-1500 ml.No postoperative death was observed but only one patient died to DIC caused by reexpansin pulmonary edema.Conclusions The thoracic giant tumor cases always accompany with severe symptoms.Surgery is effective for conservative treatment in the aspect of relieving symptoms.The principle of choosing the approach is to operate close to the tumor and to facilitate the extension of operation.Both Integrity excision and subtotal excision are acceptable.Avoiding bleeding during operation and taking measures for prevention of recurrent pulmonary edema are vital.