纵隔神经源性肿瘤手术时机和入路

目的：探讨纵隔神经源性肿瘤围手术期的处理原则。方法：回顾性分析本院手术治疗的15例纵隔神经源性肿瘤患者的病历资料。结果：1例多发神经纤维瘤病患儿颈胸交界处多个肿瘤被切除,术后局部压迫症状消失,horner征较术前加重,左臂活动受限无改善,并发脑脊液胸漏,经保守治疗痊愈;1例神经母细胞瘤患儿左锁骨下动脉壁上残留少量肿瘤组织,术后进一步行放、化疗;其余病人的肿瘤均完全切除,术前症状均有不同程度减轻或消失。结论：术前充分估计术中的特殊情况,选择恰当的手术时机和手术入路,是提高纵隔神经源性肿瘤手术切除率、减少手术并发症的关键。     

电视胸腔镜切除后纵隔神经源性肿瘤

报告２例后纵隔神经源性肿瘤在电视胸腔镜下手术切除的体会。认为纵隔单发、无严重粘连的神经源性肿瘤使用电视胸腔镜手术时间短、对病人手术创伤小，术后呼吸、咳嗽、排痰好。术后购管拔除时间早，生活质量高，住院周期短等优点。此项技术应进一步熟练，扩大临床方面的应用。     

小儿纵隔神经源性肿瘤11例

目的 探讨小儿纵隔神经源肿瘤的诊断、治疗及预后。方法 对我院小儿外科1988年至1996年11例纵隔神经源性肿瘤进行回顾性研究。年龄最小2个月,最大14岁,男:女为0.57:1。均行手术治疗。结果 本组预后良好。良性肿瘤均未复发。结论 早期诊断、早期治疗小儿纵隔神经源性肿瘤,可以明显提高小儿的生存质量。     

原发性纵隔神经源性肿瘤

我院自1957年7月至1995年7月经手术治疗原发性纵隔神经源性肿瘤64例，良性53例（占82．8％），恶性11例（占17．2％），其中神经鞘瘤33例，节细胞神经瘤12例，神经纤维瘤7例，神经纤维肉瘤4例，神经母细胞瘤3例，恶性神经鞘瘤3例，原始性神经外胚叶瘤，嗜铬细胞瘤各1例，作者对该类肿瘤的发病情况，病理分类1症状诊断及外科治疗进行了重点讨论。     

纵隔神经源性肿瘤临床病理特征和外科治疗

目的　探讨原发性纵隔神经源性肿瘤的临床病理特征和外科治疗原则。方法　总结125 例纵隔神经源性肿瘤的诊治经验。所有病例均经手术和病理证实。结果　神经源性肿瘤占同期原发性纵隔肿瘤及囊肿的22 .0 % (125/568) 。其中神经鞘瘤48 .9 % (61/125) ,神经纤维瘤27 .2 % (34/125) ,节细胞神经瘤13 .6 % (17/125) ,其他少见肿瘤10 .4 % (13/125) 。无临床症状而于查体时发现78例,占62 .4 % 。肿瘤位于后纵隔117 例。手术切除率98 .4 % (123/125) ,术后并发症发生率4 .0 % (5/125) ,手术死亡率0 .8 % 。恶性肿瘤的3 年生存率18 .2 % 。结论　纵隔神经源性肿瘤的临床特征与病理类型相关,无论良恶性均首选手术治疗,不同的病理类型有不同的预后。     

纵隔神经源性肿瘤70例临床分析

目的：探讨纵隔神经源性肿瘤的临床特点、诊断和鉴别诊断、治疗方案。方法;本组７０例均作Ｘ线检查,３４例行ＣＴ扫描,６６例接受手术治疗,恶性肿瘤行综合治疗。结果：良性肿瘤６０例术后无复发,恶性肿瘤５例平均生存３２个月,１例生存在１８年。结论;本病的临床诊断主要依靠Ｘ线检查,ＣＴ扫描更有价值。手术是治疗本病的主要方法,良性肿瘤治疗效果好,恶性肿瘤预后差。     

哑铃型纵隔神经源性肿瘤的外科治疗

目的：探讨哑铃型纵隔神经源性肿瘤的临床特征及外科治疗原则，以提高手术疗效。方法：分析7例哑铃型纵隔神经源性肿瘤的临床特征和影像学特点，所有病人均经手术治疗和病理证实。结果：肿瘤全部切除5例，次全切除2例。治愈5例，复发2例。结论：一期分别切除哑铃型纵隔神经源性肿瘤的胸腔内部分和椎管内部分。防止椎管内出血、脊髓损伤。关胸时勿使椎间孔切开处与胸腔相通，严密缝合硬脊膜，防止脑脊液漏。     

胸腔镜经剑突下与经侧胸入路行前纵隔肿瘤切除的早期效果比较

目的:探讨胸腔镜经剑突下前纵隔肿瘤切除手术的有效性和安全性。方法:收集2015年1月至2018年5月我科行胸腔镜经剑突下和经侧胸入路的前纵隔肿瘤切除患者90例,其中,经剑突下28例,经侧胸62例。比较两组手术时间、术中出血量、术后疼痛评分、术后引流时间、术后住院时间及术后并发症等指标。结果:经剑突下与经侧胸入路的胸腔镜辅助前纵隔肿瘤切除术的手术时间无明显差异,手术切除肿瘤最大直径无明显差异,但经剑突下入路组术中出血量更少（P=0.014）,术后24小时疼痛评分比侧胸入路组低（P=0.014）;经剑突下与经侧胸入路胸腔引流的时间无明显差异（P=0.09）,但经剑突下入路组术后住院时间较经侧胸入路组明显缩短（P<0.01）。经侧胸入路组1例术中中转开胸,术后2例发生肺膨胀不良,经剑突下入路组术后1例发生伤口脂肪液化。两组患者均无30天内死亡和再住院。结论:胸腔镜辅助经剑突下前纵隔肿瘤切除术安全可行,具有出血少、术后恢复快的优势。     

纵隔神经源性肿瘤的诊断与围手术期处理

目的：探讨纵隔神经源性肿瘤的诊断方法和外科治疗原则。方法：对手术治疗、经病理证实的41例纵隔神经源性肿瘤患的临床资料进行回顾性分析。结果：良性33例（81％）、恶性8例（19％），神经鞘瘤30例，神经纤维瘤6例，神经节细胞瘤5例，完整切除36例，部分切除4例，放弃手术1例，全组无死亡。结论：纵隔神经源性肿瘤好发于后纵隔，多为良性；胸部X线检查（胸片，CT）为术前主要诊断方法，术后辅助治疗取决于病理检查结果。手术为治疗首选，良性瘤和部分恶性瘤一般可获完整切除，做好围手术期处理，充分考虑到术中的特殊情况，。防止相邻重要器官损伤，是保证手术安全的关键。     

胸腔镜下双孔法治疗后纵隔肿瘤的可行性分析

目的：分析胸腔镜下双孔法治疗后纵隔肿瘤的可行性。方法回顾性分析63例后纵隔肿瘤患者的临床资料,按照治疗方法分为对照组（31例）和观察组（32例）,对照组行常规开胸手术治疗,观察组行胸腔镜下双孔法治疗。比较两组术中出血量、引流时间、住院天数和治疗总有效率。结果观察组的术中出血量和引流时间、住院天数均少于对照组,差异具有统计学意义（P﹤0.05）;观察组的治疗总有效率为96.88%,高于对照组的83.87%,差异具有统计学意义（P﹤0.05）。结论胸腔镜下双孔法治疗后纵隔肿瘤效果确切,安全性高,具有一定的临床应用价值。     

前外侧入路切除颈椎管哑铃型肿瘤4例报告

目的探讨前外侧入路切除颈段椎管内外哑铃形肿瘤的治疗效果及手术技巧。方法经前外侧入路切除颈段椎管内外哑铃形肿瘤4例,随访6个月～5年。分析临床资料及治疗效果。结果肿瘤全切4例,所有患者术后恢复良好,未出现与手术有关的并发症。结论颈前外侧入路具有椎管内外显露清楚,对颈髓、椎动脉、神经根损伤风险小等优点,是治疗颈段椎管内外哑铃形肿瘤的一种实用手术入路。     

Cross Analysis of Recurrent Types after Radical Resection of Colorectal Carcinoma

OBJECTIVE To provide the evidence of predicting and preventing the postoperative recurrence by investigating the relationship between the recurring types of colorectal carcinoma (CRC) after radical resection and clinicopathologic factors. METHODS Data from 464 CRC patients in stage I-III, who were admitted to our hospital during a period from January 1998 to December 2002 and underwent radical surgery, were collected, and retrospective analysis of the clinicopathologic data from 90 out of the 464 CRC patients, who developed postoperative recurrence was conducted. The 90 patients were divided into 2 groups based on the recurrence time (RT). Those with a RT of ≤ 30 months were classified into the early recurrence (ER) group and those with RT of > 30 months were classified into late recurrence (LR) group. The χ2 test was used for univariate analysis, and binomial logistic regression analysis for multivariate analysis. RESULTS There were 78 patients (86%) in the ER group and 12 (14%) in the LR group. The median recurrence time (MRT) was 35.1 months, 13.6 months, and 12.9 months in CRC patients with stage-I, stage-II and stage-III, respectively. There were significant differences in RT among the groups (P = 0.001). In the 90 patients, the MRT was 17.4 months. The median time (MT) was 16.9 months in patients with regional recurrence, 13.3 months in patients with single recurrence, and 7.7 months in patients with multiple metastases. Univariate analysis indicated that the depth of tumor infiltration, the number of positive lymph nodes, and the macroscopic types of the primary tumor were the factors affecting the relapse of the tumor. The multivariate analysis revealed that the depth of tumor infiltration was the independent factor affecting the time of ER (P = 0.049). CONCLUSION Most of CRC patients receiving radical surgery for colorectal cancer occur recurrence within 30 months after the first operation, nevertheless, LR occurs in some CRC patients over 30 months aft er the surgery. The time interval varies in different types of recurrence. Distant metastasis is seen mainly in the cases with postoperative ER, and regional recurrence in the cases with LR. The depth of tumor infiltration is an independent predictor affecting the postoperative RT of CRC, and the tumor infiltration into, or beyond the seromembranous layer is considered as independent factor affecting the ER of CRC.     

Surgical treatment of thoracic dumbbell tumors

BackgroundThoracic dumbbell tumors are uncommon neoplasms arising from neurogenic elements of the posterior mediastinum. Surgical removal of these tumors with mediastinal, neuroforaminal and intraspinal components can often be challenging. The purpose of this study is to present our experience of single-stage removal of dumbbell tumors of the posterior mediastinum and to discuss the surgical strategies for such tumors.MethodA retrospective analysis was performed on 20 patients who underwent surgery for thoracic dumbbell tumors at our department during the period 2008 to 2016. Patient demographics, clinical features, operative reports, and pre- and postoperative images were reviewed.ResultComplete resection was achieved in all patients, with no postoperative mortality. Surgical excision was performed by laminectomy plus Video-assisted thoracoscopic surgery (VATS) in 10 patients and laminectomy plus thoracotomy in 4 patients. Two patients underwent VATS alone. Supraclavicular and transthoracic approach was performed in 2 patients. Another 2 patients were treated with supraclavicular approach alone. The mean operative time was 244 min (range 55–370 min), with mean estimated blood loss (EBL) of 360 ml (range 50–790 ml). Postoperative complications included one case of Horner's syndrome and one case of cerebrospinal fluid (CSF) leakage. At a mean follow-up of 29 months no patients showed recurrence of the tumor.ConclusionThoracic dumbbell tumors should be evaluated for intraspinal and neuroforaminal involvement. Single-stage posterior laminectomy plus VATS/thoracotomy, VATS/thoracotomy, and supraclavicular alone or combined with transthoracic approach all could be the preferred method for removing these dumbbell tumors with satisfactory outcomes.     

下颌升支截断切除咽旁间隙巨大肿瘤

目的:探讨咽旁间隙巨大肿瘤的最佳手术入路。方法:经颈侧入路,切除腮腺浅叶同时切断下颌升支,切除咽旁间隙巨大肿瘤12例,肿瘤切除后复位固定下颌升支。术后下颌骨X-线摄片。结果:12例均完整切除肿瘤,1例术后出现Horner综合征,暂时性面瘫11例,无永久性面瘫和其他并发症。术后咬合关系正常,下颌骨对位良好。结论:经颈侧下颌升支截断切除巨大咽旁间隙肿瘤,视野良好、易于暴露,手术并发症少。     

非小细胞肺癌外科治疗联合同期非体外循环冠状动脉旁路移植术

背景与目的 外科治疗肺癌患者合并不稳定冠心病时术后死亡率和严重心血管并发症发生率较高,其治疗常给胸外科医生造成挑战.本文提出该类患者根治性肺切除术联合同期非体外循环冠状动脉旁路移植术的早期效果并总结临床经验.方法 7例可外科切除的合并心律失常、不稳定性心绞痛或近期心肌梗死的非小细胞肺癌患者,实施根治性肺叶切除术联合同期非体外循环冠状动脉旁路移植术.6例患者术前均经冠状动脉造影证实不宜行冠状动脉成形术或支架植入术,1例支架植入后效果不佳.采用胸骨正中切口,非体外循环冠状动脉旁路移植术后行肺叶切除术+纵隔淋巴结清扫术.其中左上肺叶切除2例,右上肺叶切除1例,右上、中叶切除1例,胸腔镜辅助下左下肺叶切除1例,右下肺叶切除2例.结果 本组无住院死亡,1例术后7个月因脑血管意外死亡,1例术后并发房颤.术后病理检查5例为鳞癌,2例为腺癌.全部患者随访2-59个月,术后均未再次出现心肌缺血症状,1例右肺上、中叶切除术后19个月出现局部复发.结论 在选择患者情况下,采用经胸骨正中切口根治性肺切除联合同期非体外循环冠状动脉旁路移植术对肺癌合并不稳定冠心病患者而言是一种安全有效的外科治疗方法,可能减少术后并发症的发生率.     

胸腹联合切口治疗贲门癌106例报告

为了探讨胸腹联合切口在贲门癌手术中的应用价值,回顾性分析采用胸腹联合切口治疗贲门癌106例的临床资料。结果106例手术切除90例(84.9%),其中根治性切除68例(75.6%),姑息性切除22例(24.4%),开腹探查16例(15.1%)。手术死亡1例(0.95%)。术后并发症15例(14.2%),其中肺部并发症9例,心律失常心衰5例,胸腔积液5例,切口感染6例,上切缘癌残留1例(1.1%),下切缘均无癌残留,全组无吻合口瘘。1、3和5年生存率分别为91.5%(66/72)、62.6%(27/44)和38.2%(7/18)。初步研究结果提示,胸腹联合切口治疗贲门癌较单纯经胸或经腹手术径路显露好,有利于肿瘤切除及胸腹部区域淋巴结清除,可提高手术切除率及根治性切除率。     

腮腺浅叶良性肿瘤区域切除与传统手术的比较

目的:比较腮腺浅叶良性肿瘤区域切除术与腮腺浅叶切除术的并发症与疗效,为合理选择术式提供依据。方法:回顾性分析85例腮腺浅叶良性肿瘤患者,分别采用腮腺区域切除术与腮腺浅叶切除术,随访1-3年,比较并发症与肿瘤复发情况。结果:行腮腺区域切除术41例,术后面部凹陷畸形不明显,发生暂时性面瘫4例（9.8%）,局部积液5例（12.2%）。腮腺浅叶切除术44例,术后凹陷畸形较明显,发生暂时性面瘫13例（29.5%）,局部积液14例（31.8%）,2例涎漏。两种手术方式患者在随访期间均未复发。结论:与传统腮腺术式相比,功能性区域切除术不增加复发率,且可减少术后并发症的发生。但肿瘤直径大于3cm建议行腮腺浅叶切除术。     

Diagnostic Value of Sialic Acid in Pleural Effusion

The present study was conducted in 30 patients of malignant pleural effusion and 30 patients of non malignant pleural effusion. Pleural fluid and blood samples were taken at the time of admission,before starting any treatment. Sialic acid levels were estimated in serum and pleural fluid by Warren's TBA method. In the present study,serum sialic acid levels were higher in group II as compared to group I. In the present study,pleural fluid sialic acid levels and PF/S ratio was higher in malignant pleural effus...     

胸腹联合切口治疗贲门癌106例报告

为了探讨胸腹联合切口在贲门癌手术中的应用价值，回顾性分析采用胸腹联合切口治疗贲门癌106例的临床资料。结果106例手术切除90例（84．9％），其中根治性切除68例（75．6％），姑息性切除22例（24．4％），开腹探查16例（15．1％）。手术死亡1例（0．95％）。术后并发症15例（14．2％），其中肺部并发症9例，心律失常心衰5例，胸腔积液5例，切口感染6例，上切缘癌残留1例（1．1％），下切缘均无癌残留，全组无吻合口瘘。1、3和5年生存率分别为91．5％（66／72）、62．6％（27／44）和38．2％（7／18）。初步研究结果提示，胸腹联合切口治疗贲门癌较单纯经胸或经腹手术径路显露好，有利于肿瘤切除及胸腹部区域淋巴结清除，可提高手术切除率及根治性切除率。