摘要
目的 探讨小儿纵隔、颈纵隔型淋巴管瘤的诊断和治疗。方法 分析 19例纵隔及颈纵隔型淋巴管瘤的临床资料 ,其中颈纵隔型 14例 ,瘤体均深入锁骨或胸骨到达纵隔内 ,纵隔型 5例 ,瘤体位于前上或后纵隔内。所有病例均由病理证实。结果 14例颈纵隔型中 ,2例系先行颈部病灶切除 ,术后发现纵隔病灶而再次经胸手术 ;1例先经胸行囊肿切除 ,术后再次行颈部囊肿切除 ;10例经颈胸联合切口手术 ;1例放弃手术。 5例纵隔型均侧胸入路手术。完整切除 3例 ,其他病例行囊肿揭顶引流 ,部分切除 ,残留囊壁石炭酸烧灼。术中发现左肺发育不良 1例 ,术中损伤无名静脉 1例 ,术后复发 3例 ,无死亡病例。结论 颈纵隔部位的肿瘤一经诊断应立即手术 ,切口的选择应遵循充分暴露、避免损伤的原则 ;术中不宜强求完整切除 ,残留囊腔敞向胸膜腔可减少术后复发。
Objective To discuss the diagnoses and treatment of lymphangiomas located at mediastinum or cervicomediastinum. Methods The clinical data of 19 cases of mediastinal or cervicomediastinal lymphangiomas were retrospectively reviewed. There were 14 cases of cervicomediastinal type and 5 cases of mediastinal type. All cases were pathologically diagnosed after operation. Results Among the 14 cases of cervicomediastinal type, the cervical lesions were first excised in 2 cases. Later the mediastinal lesions were discovered after operation, and thoracotomy was performed with resection of residual mediastinal lymphangiomas. The thoracotomy was first performed in one case, and the reoperation on the cervical lesion was carried out after thoracotomy. The tumor was resected through a median sternotomy with right or left extension in 10 cases. One case was not subjected to operation. The tumors were resected by lateral thoracotomy in 5 cases with mediastinal tumor. Complete resections were performed in 3 cases and the remaining were subjected to partial resection, or treatment with carbolic acid for residual lesions. During operation, the left pulmonary hypoplasia was identified in one case, innominate vein was injured in one case, and postoperative recurrence occurred in 3 cases. There were no dead cases. Conclusion The operation should be performed once the diagnosis of cervicomediatinal tumors was made. It is important to select a suitable incision in order to expose tumor sufficiently and avoid damaging important structures. It was suggested that letting the residual sack be uncovered towards to pleural cavity help to reduce the recurrence when complete resection is impossible.
出处
《华中科技大学学报（医学版）》
CAS
CSCD
北大核心
2004年第5期641-643,共3页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
