外科治疗纵隔原发神经源性肿瘤的手术径路评价

目的　探讨外科治疗原发纵隔神经源性肿瘤的手术径路。方法　 1963年 3月至2 0 0 3年 9月外科治疗原发纵隔神经源性肿瘤 91例。所有病例均于术前行X线胸片检查 ,其中 65例行CT或磁共振检查。根据肿瘤的大小、部位及其是否向椎管内延伸选择不同的手术入路 ,其中胸后外侧切口 84例 ,半哈壳状切口 2例 ,高位胸后侧切口 4例 ,胸后外侧加脊柱旁切口 1例。所有病例均经病理证实并行 6个月～ 15年的术后随访。结果　本组手术切除率 97.8% ( 89/91) ,术后并发症发生率 4.4% ( 4 /91) ,无手术死亡病例。术后病理诊断良性肿瘤 79例 ( 86.8% ) ,恶性肿瘤12例 ( 13 .4% )。 1例神经纤维瘤 2年后复发经再次手术切除治愈 ;恶性肿瘤平均生存 3 8.1个月。结论　适当的手术径路是提高纵隔原发神经源性肿瘤切除率的关键。

Evaluation of the surgical approaches of primary neurogenic tumors of the mediastinum

Objective To evaluate the surgical approaches of primary neurogenic tumors of the mediastinum.Methods The experience in treatment of 91 patients with primary neurogenic tumors of the mediastinum from March 1963 to Sep.2003 in our hospital was summarized.All the patients were examined by X-ray,and 65 of them also by CT scan or MRI.According to the size and locations of the tumors,the operations were carried out through varied approaches including lateral posterior thoracotomy (84 cases),hemiclamshell incision (2 cases),superior posterior thoracotomy (one case) and lateral posterior thoracotomy with para-vertebral approach (one case).All cases were pathologically confirmed postoperatively and followed up from 6 months to 15 years.Results In all but two patients,the tumor was resectable.The postoperative complication rate was 4.4% (4/91) without surgical death.The incidence of benign tumors was 79(86.8%),while 12(13.4%) malignant cases were identified.One case of benign tumors had recurrence after 2 years and received reoperation.The mean survival rate of the malignant patients was averagely 38.1 months.Conclusion The high resection rate of the primary neurogenic tumors of the mediastinum depends on the appropriate surgical approaches.