【摘要】 目的介绍经胸部后侧切口径路切除胸廓上口肿瘤的手术方法及疗效,为治疗该处肿瘤探索新的手术径路。方法2004年6月～2007年6月,我中心采用胸部后侧切口治疗胸廓上口部肿瘤10例,神经源性肿瘤5例,肺尖癌4例,肺尖后段肿瘤1例。皮肤切口上端自第6颈椎横突外侧,向下行于肩胛骨内侧缘与后正中线之间,切口下端绕过肩胛下角止于腋后线,将肩胛骨向前牵拉,于肿瘤投影下方切除相应肋骨(第2或第3肋)进胸,切除肿瘤。结果全组患者无手术死亡。除1例因肿瘤明显外侵行开胸探查外,其余9例均完整切除肿瘤。肩背部疼痛4例中3例术后症状缓解,2例"哑铃型"神经源性肿瘤患者双下肢无力症状明显改善,1例痛觉及腹壁反射消失者术后恢复,另1例术后双下肢肌力由Ⅱ级上升至Ⅳ级。2例出现胸腔积液需行胸腔穿刺,其余患者均顺利康复。10例患者均行门诊或电话随访3～36个月(平均18个月),其中失访1例,死亡2例,余7例无明显异常。结论胸部后侧切口对胸廓上口显露良好,增加了肿瘤的切除率及手术的安全性。更多还原

【Abstract】 Objective To introduce the procedure of thoracic outlet tumors removal through posterior thoracotomy and its efficacy.Methods Ten patients with thoracic outlet tumors underwent surgical treatment via posterior approach from June 2004 to June 2007.Five patients suffered from neurogenic tumors,4 patients apical lung carcinomas,and 1 patient apicoposterior lung tumor.The skin incision was started superiorly lateral to the transverse process of 6th cervical vertebrae,carried downward a way between the medial border of the scapula and the posterior midline and was extended in a gentle arc below the inferior angle of the scapula to the posterior axillary line.The chest was entered and the tumor is removed through resecting the rib(2nd or 3rd rib) located at the lower edge of the tumor after the scapula had been pushed forward.Results There was no death in this group.Tumors in 9 patients were resected completely.Thoracotomy only was done in another patients as a result of tumor invading neighboring major organs.Shoulder and back pain in 3 of 4 patients was remitted postoperatively.Two patients with "dumbell" neurogenic tumors improved strength of lower limbs.Pain and abdominal wall reflex resumed in one patient and muscle strength of lower limbs increased to 4th grade from 2nd grade in another one.Two patients required thoracentesis because of complicating with pleural effusion.The mean follow-up period was 18 months(range 3-36).Seven of 10 patients still lead a normal life.Conclusion Posterior thoracotomy can provide an excellent approach to remove the thoracic outlet tumors safely and completely.更多还原