【作者】 何明； 陈新； 王雷； 李月牛；

【Author】 He Ming Chen Xin Zhang He-Lin Li Yue-Niu The Forth Hospital of Hebei Medical University, ShUiazhuang 050011, China

【机构】 河北医科大学第四医院暨河北省肿瘤医院胸外科；

【摘要】 目的:探讨通过前外侧切口切除巨大纵隔肿瘤的效果。方法:选取2005年-2006年河北医科大学胸外科患有巨大纵隔肿瘤的住院病人2例,经前外侧切口,行巨大纵隔肿瘤切除手术。例1,女,32岁,主因胸闷,气短2天人院。查体:心脏向右侧移位,左胸叩实音,呼吸音消失。CT 报告:左胸13×16×20cm3肿物,内部有水样密度,脂肪组织,钙化及软组织结构,含多囊及液平,边界尚清,纵隔向右侧移位,肿瘤左缘达胸骨左缘。例2,女性,41岁,主因胸闷,气短14年于2006年3月20日入院。CT报告:纵隔巨大肿物,囊实相间,心脏向右侧移位,左肺基本被完全压缩。结果:例1于2005年10月6日经左前外侧切口第四肋间入胸,切断第三,四肋软骨,于第二肋间水平横断胸骨。见肿物来源于纵隔,占据左侧胸腔大部,肿物囊实相间。包膜尚完整,与周围组织粘连紧密,左肺被压缩,只有下叶部分充气。沿包膜仔细分离。为暴露清楚,将囊壁切开 1小切口,吸出黄色粘稠油脂样混有毛发的液体约1500ml。将肿物完整切除,仔细分离肺与胸壁之粘连,使肺充分膨胀, 常规安放引流后关胸。大体标本重1750g,可见头颅样骨骼, 依稀可辩位置对称的眼眶和鼻骨,口腔形状。病理报告:囊性畸胎瘤。患者术后恢复顺利,14天出院。例2于2006年 3月26日经左前外侧切口第四肋间入胸,切断第三,四肋软骨。为暴露清楚,将囊壁切开1小切口,吸出黄色粘稠油脂样混有毛发的液体约2000ml。将肿物完整切除,大体标本重3500g。病理报告:囊性畸胎瘤。患者术后症状明显改善, 顺利出院。结论:前外侧切口暴露纵隔和肺门血管清楚,易于控制这些血管出血,并容易向对侧胸腔延长,比较适合于偏向一侧的巨大纵隔肿瘤切除。更多还原

【Abstract】 Objective: To study the effect of operation to resect big mediastinal tumor by supine thoracotomy. Methods: Two patients with big mediastinal tumor in Thoracic Department of Hebei Medical University were treated by supine thoracotomy. Case 1 was famale, 32 year old with breathlessness and chest discomfot 2 days. The percussion of the left chest was dull and breathing was absent over the left chest The apical beat was dislocated further to the right CT showed an 13*16*20 cm3 massive in the left chest with fat density, water density and bone density. Case 2 was famale, 41 year old with breathless-ness and chest discomfort 14 years. CT showed an big massive in the mediastinum, which occupied the whole left chest Results: The tumor of Case 1 was resected through the fourth interspace. The third, fourth costal cartilages and sternum were divided. The tumor was 1750g weight beside 1500ml water inside. The tumor of Case 1 was resected through the fourth interspace. The tumor was 3500g weight beside 2000ml water inside. Pathology was teratoma. Conclusion: The blood vessels of mediastinum and hi-lum can be showed clearly by supine thoracotomy. It can be prolonged easily and suit to resect big mediastinal tumor.更多还原