摘要
目的总结原发性颈胸结合部肿瘤的诊治经验。方法统计2005年3月至2009年12月在解放军总医院住院手术并经病理确诊的17例患者的临床资料，对患者的临床表现、手术方法选择及并发症预防进行分析。17例患者的肿瘤主体位于左侧9例，右侧8例。行颈侧切开（阶梯切口）1例，颈胸联合手术3例，颈根部及锁骨上切开6例，颈根部及上纵隔肿瘤切除7例，3例神经纤维瘤患者因肿瘤与局部重要组织结构粘连严重未能全部切除。结果5例（29．4％）患者发生手术并发症，其中1例术中左锁骨下动脉破裂出血及喉返神经损伤，术后伤口感染、皮肤缺损；1例术中椎动脉和颈总动脉破裂，术后出现霍纳综合征伴上肢运动受限和不能耸肩；1例手运动障碍；2例上肢运动受限。术后病理结果：囊肿、静脉血管瘤、节细胞神经瘤、纤维源性肿瘤、纤维肉瘤、脂肪肉瘤、肌纤维母细胞瘤、异位错构瘤性胸腺瘤（腮原基混合瘤）各1例，神经纤维瘤3例，神经鞘瘤6例。随访1．0—4．5年，中位时间2．5年。2例恶性肿瘤患者随访3年8个月和2年，均无瘤存活；3例神经纤维瘤未完全切除患者带瘤生存，其余12例良性病变暂无瘤生存。结论原发性颈根部肿瘤类型多，其中神经鞘瘤较多；当肿瘤范围广泛、与局部神经血管等重要结构粘连紧密时，手术难以彻底切除，其手术并发症发生率高。
Objective To investigate the diagnosis and treatment of the primary tumors at the cervicothoracic junction. Methods Seventeen cases of the tumors at the cervicothoracic junction were diagnosed by surgery and histopathology in Chinese PLA General Hospital from Mar 2005 to Dec 2009. The clinical manifestions, the surgical approaches and surgical complications were analyzed retrospectively. Results The operation approches included the lateral cervical incision（ 1 patient）, the combined cervical and thorax incision（ 3 patients）, the supraclavicle cervical incision （6 patients）, and the combined cervical incision and superior mediastinotomy （7 patients）. Except 3 cases in whom the tumors surrounded or sticked to vital blood vessels or nerves had experienced subtotal resection, the remained 14 cases had total ablation. The morbidity occurred in 5 patients, including subclavian artery, vertebral artery or common carotid artery rupture, recuurent laryngeal nerve trauma, brachial plexus trauma and Horner＇syndrome. The histopathology included the cyst, the venous haemangioma, the nodus cell neuroma, the fibroma, the fibrosarcoma, the liposarcoma, the myofibroblastic tumor, the ectopic hamartomous thymoma, the neurofibroma, and neurinoma. The patients were followed up from 1 to 4.5 years post-operatively, with a median of 25.3 months. The two malignant patients were alive being free of tumor with follow-up of 3.7 years and 2 years respectively. The three cases with tumor partial resection were all alive with tumour. The remained 12 benign cases with total tumor ablation were alive free of tumour. Conclusions The histopathology of tomours at the eervicothoracic junction is diversity. But the commonest pathology is neurinoma. When the tumor is extensive, enveloping or involving the vital blood vessel and nerve, total ablation of tumour is difficult, and the morbidity is very high.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2012年第11期922-925,共4页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
头颈部肿瘤
颈
胸部
Head and neck neoplasms
Neck
Thorax
