胸腔镜手术治疗后纵隔良性神经源性肿瘤40例报告

目的 探讨胸腔镜在后纵隔神经源性肿瘤治疗中的价值. 方法 1994年5月～2006年5月,经胸腔镜手术切除40例后纵隔良性神经源性肿瘤,全麻双腔气管插管,套管切口根据肿瘤位置而定,如肿瘤过大,切除困难,可辅助小切口. 结果 34例经胸腔镜顺利完成肿瘤切除,6例附加6 cm小切口完成手术.神经鞘瘤20例,神经纤维瘤14例,神经节细胞瘤6例.肿瘤直径平均4.7 cm（2～12 cm）.术后平均胸腔闭式引流2.2 d（1～7 d）.术后平均住院4.8 d（3～13 d）.轻微并发症2例,无手术死亡.随访9个月～12年,其中＜3年16例,3～5年12例,＞5年7例,失访5例.局部复发1例,接受二次手术治疗. 结论 胸腔镜切除后纵隔良性神经源性肿瘤安全、可靠、创伤小,可作为该疾病的首选治疗方法.

Video-Assisted Thoracoscopic Resection of Posterior Mediastinal Benign Neurogenic Tumors: An Analysis of 40 Cases

Objective To evaluate the therapeutic value of video-assisted thoracoscopy in treating posterior mediastinal benign neurogenic tumors.Methods From May 1994 to May 2006,40 patients received thoracoscopic resection of posterior mediastinal benign neurogenic tumor.Double lumen endotrocheal intubation was applied and 3 trocars were placed according to the location of the tumor.A mini-incision was used if the tumor was too large to be safely resected.Results The complete resections were successfully finished in 34 cases while the remaining 6 cases needed a 6 cm mini-incision to complete the surgery.Pathological examination showed 20 cases of neurilemoma,14 cases of neurofibroma,and 6 cases of paraganglioma.The average diameter of these tumors was 4.7 cm(range:2-12 cm).The average thoracic drainage time was 2.2 days(1-7 days).And the average postoperative hospital stay was 4.8 days(3-13 days).Only 2 cases experienced minor complications.There was no death in this study.The time of follow-up was 9 months to 12 years,in which 16 cases were followed for less than 3 years,12 cases for 3-5 years and 7 cases for over 5 years,5 cases lost contact.Only one patient received re-resection due to local recurrence.Conclusions Video-assisted thoracoscopic resection of posterior mediastinal benign neurogenic tumor is safe,reliable and minimally invasive,and can thus be regarded as the therapy of first choice.