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目的探讨复杂性纵膈孤立性纤维性肿瘤(solitary fibrous tumor,SFT)的临床特点、诊断及外科治疗方法,分析此类疾病的治疗预后情况。方法回顾性分析2014年5月—2015年6月蚌埠医学院第一附属医院收治的经术后病理和免疫组织化学分析确诊的3例复杂性纵膈SFT患者的临床资料,结合术后随访情况进行分析。3例患者临床表现:刺激性干咳为主1例,胸闷、气短1例,胸部不适感1例。术前均行胸部增强CT检查等常规检查,未见转移等其他手术禁忌症,术前充分准备,根据肿瘤所在的部位,选择不同的外科手术方法。手术方式:1例左后下纵膈肿瘤经左进胸行肿瘤切除术;1例左后下纵膈肿瘤经左进胸行肿瘤切除联合左下肺叶切除术;1例右后下纵膈肿瘤经右进胸行肿瘤切除术,并在外侵严重处用钛夹标记,术后4周行放射治疗。随访主要复查项目为术后1个月复查胸部X线片,术后3~6个月复查胸部CT,术后1~3年每年复查一次胸部CT。结果 3例患者均手术顺利,肿瘤完整切除。其中1例患者术后出现胸闷症状加重,经对症处理后好转。3例患者均获得随访,随访期间均无复发及转移。结论复杂纵膈孤立性纤维性肿瘤是一种少见的纵膈肿瘤,诊断需经病理及免疫组织化学分析,首选外科手术治疗,完整切除预后良好,需严密随访,外侵严重术后需辅助放疗。
Objective To investigate the clinical features, diagnosis and surgical treatment of complicated mediastinal solitary fibrous tumor (SFT) and analyze the prognosis of these diseases. Methods The clinical data of 3 patients with complicated mediastinum SFT confirmed by postoperative pathology and immunohistochemical analysis admitted to the First Affiliated Hospital of Bengbu Medical College from May 2014 to June 2015 were retrospectively analyzed. Combined with postoperative follow-up Analyze. 3 cases of clinical manifestations: irritating dry cough in 1 case, chest tightness, shortness of breath in 1 case, chest discomfort in 1 case. Preoperative chest thoracic enhanced CT examination and other routine examination, no metastasis and other surgical contraindications, fully prepared before surgery, according to the site of the tumor, choose a different surgical methods. Surgical methods: one case of left posterior mediastinum and left posterior mediastinum tumor resection; one case of left posterior mediastinum and left posterior mediastinum resection and left lower lobectomy; one case of right posterior mediastinum Right into the chest line tumor resection, and in severe cases of external invasion with titanium clip mark, 4 weeks after radiotherapy. Follow-up of the main review items for 1 month after the review of chest X-ray film, 3 to 6 months after the review of chest CT, 1 to 3 years after the review of a chest CT each year. Results All 3 patients underwent surgery successfully and the tumor was completely resected. One case of postoperative chest tightness symptoms worsened after symptomatic improvement. Three patients were followed up, no recurrence and metastasis during follow-up. Conclusions The complex mediastinum solitary fibrous tumor is a rare mediastinal tumor. The diagnosis needs to be analyzed by pathology and immunohistochemistry, and the surgical treatment is the first choice. The complete resection has a good prognosis and needs close follow-up. Severe external invasion requires adjuvant radiotherapy .