胸顶部肿瘤外科治疗27例临床分析

目的　探讨前径路技术在胸顶部肿瘤手术治疗中的应用及其优势。　方法　从 1995年 1月至 2 0 0 1年 1月 ,手术治疗原发性胸顶部肿瘤患者 2 7例 ,平均年龄 4 9 2岁。病理类型包括非小细胞肺癌、肉瘤、神经纤维瘤、颈段食管癌等。通过对临床表现、肿瘤类型及外侵范围、手术径路及切除程度、并发症、生存期等资料进行分析 ,评估前径路对手术安全性和彻底性的帮助以及对延长生存期的作用。　结果　 6例采用前径路半蛤壳切口 ,全部得到完全切除 ;2 1例采用后径路Paulson切口 ,其中 13例为完全切除 ,8例为姑息性切除。随访 2 3～ 4 6个月 (平均 2 9个月 ) ,总的中位生存期为2 1个月 ,其中完全切除者为 2 9个月 ,姑息切除者为 14个月 ,两者差异有显著意义 (P <0 0 1)。前径路的完全切除率明显高于后径路 (χ2 =1.6 78,P <0 0 1)。　结论　前径路切口可显著改善胸顶结构的暴露 ,尤其对于锁骨下血管、臂丛神经等结构可在直视下予以解剖 ,从而增加了手术的安全性和彻底性。

Surgical treatment of apical chest tumor in 27 patients

OBJECTIVE: To explore the "hemi-clamshell" approach to the resection of the apical chest tumors, and to evaluate its advantages of operative safety and completeness. METHODS: We conducted a retrospective review of the records of 27 patients undergoing resection of the primary apical chest tumors from January 1995 to January 2001. Tumor type included NSCLC, sarcoma, neurofibromatosis, esophageal carcinoma. Data collected included clinical presentation, tumor type and involvement, type of resection, complication, and survival. RESULTS: A clinical operation for gross-total resection of tumors and invaded structures was performed on six patients by means of a successful anterior approach. Among other 21 patients on whom a clinical operation was performed by posterior approach, only 13 patients obtained gross-total resection. There were significant difference between the two groups (P < 0.01). The mean duration for follow-up was 29 months, and the overall median survival was 21 months. Median survival in patients undergoing gross-total resection was 29 months, and this is significantly better than in incomplete resection group (P < 0.01). CONCLUSIONS: The anterior "hemi-clamshell" approach is a successful technique for the exposure and resection of these tumors and invaded structures. Release of symptoms and long-term survival is acceptable if complete resection can be performed.