Bastos Pedro, Magalhães Adriana, Fernandes Gabriela, Cruz Maria Rosa, Saleiro Sandra, Gonçalves Luís, Piñon Miguel
Autonomous Surgery Management Unit, Faculty of Medicine. Hospital de S. João.
Rev Port Pneumol. 2007 Sep-Oct;13(5):659-73. doi: 10.1016/s2173-5115(07)70361-5.
To assess results in patients with primary cysts and tumours of the mediastinum who under- went surgery.
A retrospective single-centre study was undertaken into patients with primary cysts and tumours of the mediastinum who underwent surgery between January 1992 and December 2004. We analysed demographic data, clinical presentation, type of surgery carried out and procedure, lesion location and histological diagnosis. Predictive malignancy factors were also evaluated. Postoperative morbidity and mortality were noted, as was medium-term results.
171 patients underwent surgery over a 13-year period; 73 female (43%) and 98 male (57%). Mean age was 40.3+/-19.7 years (20 days-78 years). A primary cystic lesion was present in 15 patients (9%). The pri- mary tumours included thymic neoplasms (31%), lymphoma (22%), neurogenic tumours (16%), germ cell tumours (9%) and a miscellaneous group (13%). Malignant neoplasms were present in 78 patients (46%). The antero-superior mediastinum was the most commonly involved site to have a primary cyst or tumour (58%), followed by the posterior mediastinum (24%) and the middle mediastinum (18%). Symptoms were present in 68% of the patients and included chest pain (20%), fever and chills (13%), myasthenia gravis (11%), cough (10%), dyspnoea (10%), and superior vena caval syndrome (7%). Univariate analysis identified symptoms as a predictive factors of malignancy (p<0.001). Types of surgery carried out included postero-lateral thoracotomy (64 patients), median sternotomy (51 patients), anterior mediastinostomy (27 patients), antero-lateral thoracotomy (18 patients), video-assisted thoracic surgery (9 patients) and mediastinoscopy (2 patients). Total excision was performed in 116 patients, enlarged resection in 8 patients, subtotal re- section in 7 patients and biopsy in 40 patients. There was one postoperative death (0.6%). Follow-up was available in 165 patients (96.5%) and ranged from 34 days to 13.4 years (mean 5.7+/-4.0 years). Complementary treatment with chemo and/or radiotherapy was provided in 75 patients. Six patients had to be reoperated on for local recurrence (3) or metastasis (3) of the primary lesion. Fifteen patients died of their disease during the follow-up period. Actuarial survival at five years was 97.6% for benign lesions and 76.4% for malignant tumours.
Results support surgical resection for benign lesions and an aggressive multimodal approach for malignant tumours.
评估接受手术治疗的原发性纵隔囊肿和肿瘤患者的治疗结果。
对1992年1月至2004年12月期间接受手术治疗的原发性纵隔囊肿和肿瘤患者进行一项回顾性单中心研究。我们分析了人口统计学数据、临床表现、所实施的手术类型和步骤、病变位置以及组织学诊断。还评估了预测恶性肿瘤的因素。记录术后发病率和死亡率以及中期结果。
171例患者在13年期间接受了手术；女性73例（43%），男性98例（57%）。平均年龄为40.3±19.7岁（20天至78岁）。15例患者（9%）存在原发性囊性病变。原发性肿瘤包括胸腺肿瘤（31%）、淋巴瘤（22%）、神经源性肿瘤（16%）、生殖细胞肿瘤（9%）和其他类型（13%）。78例患者（46%）存在恶性肿瘤。前上纵隔是原发性囊肿或肿瘤最常累及的部位（58%），其次是后纵隔（24%）和中纵隔（18%）。68%的患者出现症状，包括胸痛（20%）、发热和寒战（13%）、重症肌无力（11%）、咳嗽（10%）、呼吸困难（10%）和上腔静脉综合征（7%）。单因素分析确定症状是恶性肿瘤的预测因素（p<0.001）。所实施的手术类型包括后外侧开胸术（64例患者）、正中胸骨切开术（51例患者）、前纵隔切开术（27例患者）、前外侧开胸术（18例患者）、电视辅助胸腔镜手术（9例患者）和纵隔镜检查（2例患者）。116例患者进行了完整切除，8例患者进行了扩大切除，7例患者进行了次全切除，40例患者进行了活检。术后有1例死亡（0.6%）。165例患者（96.5%）获得随访，随访时间为34天至13.4年（平均5.7±4.0年）。75例患者接受了化疗和/或放疗的辅助治疗。6例患者因原发性病变的局部复发（3例）或转移（3例）而不得不再次手术。15例患者在随访期间死于疾病。良性病变的5年精算生存率为97.6%，恶性肿瘤为76.4%。
结果支持对良性病变进行手术切除，对恶性肿瘤采取积极的多模式治疗方法。
