论文部分内容阅读
目的总结累及心脏大血管的复杂纵隔肿瘤外科处理原则。方法回顾性分析1997年2月至2014年5月38例累及心脏大血管的复杂纵隔肿瘤的围术期处理情况。男26例,女12例,年龄4~68(41.3±13.6)岁。采取多种个性化切除重建术式,部分患者综合采用两种或以上的技术,总计行右房部分切除3例,大血管切除、成形、置换16例,心包部分切除修补10例,肺楔形切除8例,肺叶切除2例;其中2例在体外循环下进行。结果所有患者均顺利完成手术,无围术期死亡,手术时间105~282 min,出血量200~1 500 ml,术后平均住院时间11.2 d,ICU住院率47.4%,ICU平均住院时间1.8 d。并发症发生率23.7%,5年生存率57.0%。结论累及心脏大血管的复杂纵隔肿瘤手术难度及危险性较大,只要做好充分的围术期准备,采取适当术式,可安全顺利完成手术并达到理想的治疗效果。
Objective To summarize the principles of surgical management of complex mediastinal tumors involving the large vessels of the heart. Methods The perioperative management of 38 patients with complex mediastinal vessels involving the heart vessels from February 1997 to May 2014 were retrospectively analyzed. There were 26 males and 12 females, ranging in age from 4 to 68 (41.3 ± 13.6) years. To take a variety of personalized resection and reconstruction of surgery, some patients using a combination of two or more technologies, a total of 3 cases of right atrium partial resection, major vessel resection, shaping, replacement of 16 cases, partial resection of the pericardium in 10 cases, pulmonary wedge resection 8 cases, lobectomy in 2 cases; 2 cases under cardiopulmonary bypass. Results All the patients completed the operation successfully without perioperative death. The operation time was 105-282 min. The bleeding volume was 200-1 500 ml. The average postoperative hospital stay was 11.2 days. The ICU hospitalization rate was 47.4% and the average ICU hospitalization time was 1.8 days. The complication rate was 23.7% and the 5-year survival rate was 57.0%. Conclusions The complicated mediastinal tumors involving the large blood vessels of the heart are more difficult and dangerous to be operated on. As long as adequate perioperative preparation and adequate surgical procedures can be performed, the operation can be completed safely and the ideal therapeutic effect can be achieved.