原发性纵隔肿瘤384例外科治疗分析

目的 探讨原发性纵隔肿瘤的临床特点、诊断方法、外科治疗。方法 回顾分析14年来我院收治的384例原发性纵隔肿瘤。结果 384例中，胸腺瘤147例，占38．3％，畸胎瘤70例，占18．2％，神经源性肿瘤66例，占17．2％，纵隔囊肿32例，占8．3％。X线与术后病理诊断的基本符合率为79．2％，而CT的基本符合率为92．4％；全组病例均行手术治疗，肿瘤完全切除者336例，部分切除者29例，探查加活组织检查者19例。手术切除率为95．1％(365／384)。手术死亡6例，病死率1．6％。结论 本病诊断主要依靠X线片、CT等影像学检查；诊断一经成立，应尽早手术治疗，正确选择切口，恶性胸腺瘤手术治疗原则是即使不能完整切除肿瘤也应尽早将可切除部分切除，复发的胸腺瘤仍有手术指征。

Primary mediastinal tumors:findings of 384 cases

Objebtive To explore the clinical features, diagnosis and surgical treatment of primary mediastinal tumors (PMT). Methods A retrospective analysis of 384 patients with PMT and cysts over a 14-year period was performed. Results In the 384 cases, the most common tumor was thymoma ( 38.3%), followed by teratoblastomas ( 18.2%), neurogenic tumors ( 17.2%), and mediastinal cycts ( 8.3%). Surgical interventions were performed in all cases. 365 patients were subjected to radical excision, 29 to palliative excision and 19 to exploractomy thoractomy. Thecorresponding rate between preoperative x-ray examination and postoperative pathological examination was 79.2%, and the rate between CT examination and the pathological examination was 92.4%. The respectable rate of operation was 95.1%. Six patients died during operation with the mortality being 1.6%. Conclusion Chest x-ray and CT examinations are the common access to diagnose PMT. Once the diagnosis of PMT is established, the surgical treatment should be performed as soon as possible. Correct selection of the incision and prevention of important organ injuries are the keys to operation. The surgical principle of malignant thymoma is to resect the tumor completely, at least in part.