Topçu S, Alper A, Gülhan E, Koçyigit O, Tastepe I, Cetin G
Atatürk Chest Disease and Chest Surgery Centre, Ankara, Turkey.
Can Respir J. 2000 May-Jun;7(3):261-5. doi: 10.1155/2000/782325.
To analyze retrospectively 60 patients (13 infants and children, 47 adults--21 men and 39 women) with mediastinal neurogenic tumours admitted to Atatürk Centre for Chest Disease and Chest Surgery, Ankara, Turkey between 1988 and 1999. This comprised 21.2% of 283 patients who had surgical operations for all mediastinal masses during the same period.
The patients ranged from four to 67 years of age. Thirteen patients were younger than 15 years and 47 were 15 years of age or older. Medical records were reviewed for demographic data, clinical presentation, diagnostic investigations, operative procedures, and tumour location and invasion. Postoperative morbidity and mortality were noted as well as long term follow-up. The clinical investigations included chest x-ray and computed tomography of the thorax in all patients, and spinal magnetic resonance imaging and bronchoscopical examination in some. Clinical variables were compared.
The tumours had the following characteristics: 42 (70%) were nerve sheath tumours; 15 (25%) were autonomic ganglion tumours; two (3.6%) were paragangliomas; and one (1.4%) was a malignant peripheral neuroectodermal tumour (Askin's tumour). Nerve cell tumours comprised the majority of tumours in infants and children (nine of 13, 69%), whereas the nerve sheath tumours were most frequent in adults (39 of 47, 83%). There were 48 benign and 12 (20%) malignant tumours when all age groups were considered; the malignancy rate was 61.5% (eight of 13) in children and 8.5% (four of 47, P<0.05) in adults. All patients were operated via a posterolateral thoracotomy. Surgical resection of the tumour was complete in 56 of 60 patients (93.3%). Resection of malignant tumours was grossly incomplete in four cases (four of 12, 33.3%). All benign tumours were totally excised. There were two major complications (respiratory failure and pulmonary emboli) and 14 minor complications in the perioperative period. The mean follow-up period was five years and seven months. Tumours recurred in 5.3% (three of 56) of patients who had a complete resection initially. There were no late deaths related to benign tumours.
Complete resection of tumours can be performed safely by a thoracotomy approach and is important for achieving satisfactory long term survival in most mediastinal neurogenic tumours.
回顾性分析1988年至1999年间收治于土耳其安卡拉阿塔图尔克胸科疾病与胸外科中心的60例纵隔神经源性肿瘤患者（13例婴幼儿及儿童，47例成人——21例男性，39例女性）。这占同期因所有纵隔肿物接受手术治疗的283例患者的21.2%。
患者年龄范围为4岁至67岁。13例患者年龄小于15岁，47例患者年龄在15岁及以上。查阅病历以获取人口统计学数据、临床表现、诊断检查、手术操作以及肿瘤位置和侵犯情况。记录术后发病率和死亡率以及长期随访情况。临床检查包括所有患者的胸部X线和胸部计算机断层扫描，部分患者还进行了脊柱磁共振成像和支气管镜检查。对临床变量进行比较。
肿瘤具有以下特征：42例（70%）为神经鞘瘤；15例（25%）为自主神经节肿瘤；2例（3.6%）为副神经节瘤；1例（1.4%）为恶性外周神经外胚层肿瘤（阿斯基肿瘤）。神经细胞瘤在婴幼儿及儿童肿瘤中占大多数（13例中的9例，69%），而神经鞘瘤在成人中最为常见（47例中的39例，83%）。考虑所有年龄组时，有48例良性肿瘤和12例（20%）恶性肿瘤；儿童的恶性率为61.5%（13例中的8例），成人的恶性率为8.5%（47例中的4例，P<0.05）。所有患者均通过后外侧开胸手术。60例患者中有56例（93.3%）肿瘤手术切除完整。12例恶性肿瘤中有4例（4例，33.3%）大体切除不完整。所有良性肿瘤均被完全切除。围手术期有2例主要并发症（呼吸衰竭和肺栓塞）和14例次要并发症。平均随访期为5年7个月。最初手术切除完整的患者中有5.3%（56例中的3例）肿瘤复发。没有与良性肿瘤相关的晚期死亡病例。
通过开胸手术方法可安全地完整切除肿瘤，这对于大多数纵隔神经源性肿瘤实现满意的长期生存很重要。
