纵隔病变405例临床病理分析

目的：探讨纵隔病变的临床病理特征。方法：对1967－1997年外科切除的405例纵隔病变组织进行分析。结果：男216例，女189例，中位年龄26岁；肿瘤及瘤样病变230例（56．8％），重症肌无力（MG）172例（42．5％）；在肿瘤性病变中，胸腺肿瘤113例（49．1％）居首位，平均年龄40岁；生殖细胞瘤36例（15．7％），神经源性肿瘤30例（13％），淋巴瘤仅6例（2．6％），囊肿29例（12．6％）。前纵隔肿瘤165例（71．7％），主要为胸腺肿瘤；中纵隔肿瘤6例；后纵隔肿瘤30例，主要系神经源性肿瘤。非肿瘤性病变中，MG胸腺淋巴滤泡性增生145例（84．3％），无增生者27例（15．7％）；MG伴胸腺肿瘤38例（22．1％），其中微小胸腺瘤12例（6．9％）。结论：MG胸腺伴有淋巴滤泡性增生者，预后好于胸腺非增生和胸腺瘤者，MG胸腺病理诊断对于发现微小胸腺瘤具有一定重要性。纵隔内胸腺肿瘤几乎占肿瘤病变的半数，国人淋巴瘤发病率较低，多数（84．3％）MG患者胸腺表现淋巴滤泡性增生。

A clinicopathological analysis of 405 cases of mediastinum lesions

Objectives:To study the clinicopathological changes of mediastinum lesions. Methods:Specimens from 405 cases of mediastinum lesions from 1967 to 1997 were studied. Results:Sex ratio, male to female was 216 to 189, median age was 26 years. There were 230(56.8%) cases of tumors and tumor like lesions, 172(42.5%) cases manifested with myasthenia gravis. Case composition, 113 cases of thymus lesion(49.1%), 36 cases(15.7%) of germ cell tumors, 30 cases(13.0%) of neurological neoplasm, 6 cases(2.6%) of lymphoma, and 29 cases(12.6%) of cysts. Location, 165 cases(71.7%) were in the front mediastinum in which thymoma was the commonest, 6 cases(2.6%) were in the middle mediastinum in which lymphoma was the commonest, 30 cases were from the posterior mediastinum in which neurological tumors were the commonest. Follicular proliferation of the thymus was observed in 145 cases(84.3%) of MG, and 27 cases did not(15.7%) . Thirty eight cases(22.1%) of MG were from thymoma, and 12 cases(7.0%) from microscopic thymoma. Conclusions: Prognosis of MG with thymus follicular proliferation was better than those without proliferation and thymoma, fortunately, most thymus with MG were follicular proliferative. Microscopic thymoma could be discovered on pathology. Thymus tumors consisted more than half of the mediastinum neoplasm, the incident of lymphoma was low.