胸内巨大实质性肿瘤的诊断与外科治疗

目的 探讨胸内巨大实质性肿瘤的诊断与外科治疗经验.方法 回顾性分析经手术治疗的36例胸内巨大肿瘤患者的临床资料.其中肿瘤彻底切除34例,同期行上腔静脉成形术3例,左无名静脉结扎术2例.6例患者术后加用放射治疗.结果 36例患者中,围术期死亡2例,占5.6%.术后平均住院时间为14.2 d.症状明显改善者32例,术后出现复张性肺水肿6例.随访1～22年,良性肿瘤患者平均存活时间为10.0年,恶性肿瘤患者平均存活时间为2.1年.结论 对胸内巨大实质性肿瘤患者尽可能采取手术治疗,即使不能彻底根治,术后加用放射治疗也能取得良好疗效.选择正确的麻醉方法与合适切口,结合具体情况采取不同的切除方式和止血方法是成功的关键.

Diagnosis and surgical treatment of giant intrathoracic solid tumors

Objective To summarize the experience in diagnosis and surgical treatment of giant intrathoracic solid tumors. Methods The data of surgically treated 36 patients with giant intrathoracic solid tumors were analyzed, including 19 males and 17 females. Complete resection was achieved in 34 cases with superior vena cava angioplasty in 3 cases and ligation of the left anonymous vein in 2 cases. Six patients received postoperative radiotherapy. Results The symptoms in 32 cases were significantly improved. Two patients (5.6%) died of postoperative respiratory infection and failure. The mean postoperative hospital stay was 14.2 days. Pulmonary edema occurred in 6 cases due to rapid decompression of the lung. Pathological results showed that 25 cases had benign tumors and 11 had malignancy. During the follow-up of 1 to 22 years, all patients with benign tumors were still alive, but the patients with malignant tumors had a mean survival time of only 2. 1 years. Conclusion Surgical treatment for giant intrathoracic solid tumors is suggested whenever technically possible. Even though a tumor can not be completely resected, satisfied results could still be achieved if combined with postoperative radiotherapy. Proper anesthesia, satisfied exposure with a suitable incision, appropriate resection pattern and hemostatic method are the keys for successful surgical treatment.