原发性纵隔肿瘤的诊断和外科治疗

目的 探讨原发性纵隔肿瘤的临床特点及外科治疗的方法和效果.方法 回顾性分析2004年7月至2009年6月经病理检查确诊的原发性纵隔肿瘤住院患者31例患者的临床资料.结果 31例中前纵隔肿瘤18例,后纵隔肿瘤9例,中纵隔肿瘤4例;肿瘤直径＞10 cm者12例,最大直径达14.5 cm.病理检查良性肿瘤25例,恶性肿瘤6例;肿瘤全切除26例,姑息性切除5例.出院随访3个月～5年,良性肿瘤术后未见复发.1例患者术后肺部转移给予放化疗,未行二次手术,2例年轻胸腺癌患者分别于术后4、7个月死于肿瘤复发.结论 原发纵隔肿瘤的诊断主要依赖胸部X线和CT检查,手术为首选治疗方法.选择合适的手术入路是手术成功的关键.

The diagnosis and surgical treatment of primary mediastinal tumor

Objective To investigate the clinical features of primary mediastinal tumor and the surgical treatment methods and effectiveness. Methods Clinical data of 31 cases with primary mediastinal tumor confirmed by pathological examination were retrospectively collected and analyzed from July 2004 to June 2009. Results Totally 18 of 31 cases were with anterior mediastinal tumor, 9 cases with meta-mediastinal tumor and 4 cases with middle mediastinal tumor. Diameter of tumor were over 10 cm in 12 cases and the largest diameter was 14.5 cm. Benign pathology was found in 23 cases, and malignant tumor in 6 cases. Total resection of tumor was in 26 cases, and palliative resection was in 5 cases. Follow-up 3 months to 5 years, no recurrence was found in patients with benign tumor; only 1 patient with lung metastasis was accepted radiotherapy and chemotherapy. Two young patients with thymic carcinoma died of tumor recurrence at 4 months, 7 months respectively. Conclusions The diagnosis of primary mediastinal tumors relies mainly on the chest X ray and chest CT examination and surgical treatment is first choice. The key point is reasonable choice of surgical approach.