巨大纵隔肿瘤的诊断和外科治疗 (附17例分析)

目的探讨巨大的纵隔肿瘤诊断和手术治疗经验。方法回顾分析17例巨大纵隔肿瘤患者临床资料，全组病例经胸骨止中切口或胸部后外侧切口入路，行纵隔肿瘤切除。其中9例行单纯肿瘤摘除，2例行肿瘤切除＋上腔静脉置换，3例行无名静脉有心房转流，3例姑息性切除。结果全组病例近期均恢复良好，无同手术期死亡。随访6个月～10年，3例患者于术后2～3年因肿瘤转移死亡，1例患者术后1年因纵隔感染死于大咯血。其余患者均健康存活。结论巨大纵隔肿瘤手术的入路选择及术中处理对于手术成功至关重要，术前应尽量明确肿块的主要接触面，手术切口应具有一定的灵活性，以保证充分暴露术野。

Surgical treatment for giant mediastinal tumor

Objective To review the experience of diagnosis and surgical treatment for giant tumor of mediastinum.Methods Analysis the 17 cases giant mediastinal tumor, we perform the operation through sterno-median incision or thoracic post-lateral incision ,among them single tumor excision in 9 cases , tumor excision plus SVC replacement in 2 cases, anonymous veins-right atrium by-pass in 3 cases, indulgent excision in 3 cases.Results There was no perioperative death occurred, during the period of 6 mouths to 10 years after operation, 3 patients died of metastasis after 2-3 years, 1 patient died of serious hemoptysis caused by mediastinal infection, the others were survival.Conclusion It is very important for the approach and handling to the operation of giant mediastinal tumor,we should identify the contact surface of tumor and obtain the clear operating field.