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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。
Objective To investigate the surgical approach of surgical treatment of primary mediastinal neurogenic tumors. Methods Surgical treatment of 91 patients with primary mediastinal neurogenic tumors from March 1963 to September 2003. All cases were preoperative X-ray examination, of which 65 cases of CT or magnetic resonance imaging. According to the tumor size and location and whether it is to extend to the spinal canal to choose a different surgical approach, including 84 cases of lateral thoracic incision, half of the hemispherical incision in 2 cases, 4 cases of high posterior thoracotomy, lateral thoracic plus spine Side incision in 1 case. All cases were pathologically confirmed parallel 6 months to 15 years follow-up. Results The resection rate of this group was 97.8% (89/91), the incidence of postoperative complications was 4.4% (4/91), there was no surgical death. Postoperative pathological diagnosis of benign tumors in 79 cases (86.8%), 12 cases of malignant tumors (13.4%). One case of neurofibroma recurred after 2 years of resection and cure; the average survival of malignant tumor was 8.1 months. Conclusion Appropriate surgical approach is the key to improve resection rate of primary neurogenic tumors in mediastinum.