Laín A, Parente A, Cañiizo A, Fanjul M, García-Casillas M A, Matute J A, Vázquez J
Servicio Cirugía Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid.
Cir Pediatr. 2008 Apr;21(2):111-5.
Surgical approach of the cervicothoracic junction has been traditionally done by cervicotomy and/or thoracotomy. Nevertheless, this access does not allow a suitable control of vasculonervous structures. Due to this we present our experience with a variation of the "Trap-door" thoracotomy which gives the best access to this area applied to pediatric patients
We present 4 patients of 2.8 +/- 1.9 years of age treated in our hospital by a cervicothoracotomy transmanubrial approach without clavicular luxation. One patient presented a stage IV cervicothoracic neuroblastoma, 1 patient had a cervicothoracic lymphangioma, one a severe cervicothoracic scoliosis and one a total cricoid atresia associated to an oesophageal atresia type IIIc (Vogt). This surgical approach allowed a perfect control of brachiocefalic and nervous structures as well as a correct visualization of all the cervicothoracic intervertebral foramina. Postoperative pain was controlled by epidural catheters, oral analgesic treatment was introduced in the fifth postoperative day.
Complete resection and surgical treatment was possible in all patients, not being necessary the section of any vascular or nervous structure. There were no intraoperatory or postoperative complications. One patient presented a temporary Homer's syndrome. No tumoral recurrence has been noted after a mean follow-up of 2.3 +/- 3.1 years. CONCLUSION. The modified "Trap-door" approach allows a good control of the brachiocephalic structures and a complete visualization of the upper thorax and posterior mediastinum. Due to its low morbidity this access may be very useful since it allows an important vascular control and an excellent surgical field. Our modification of the "Trap-door" approach avoids clavicular luxation and has the advantage of no sequelaes in the functionality of the escapulo-humeral articulation.
传统上，颈胸交界区的手术入路是通过颈部切开术和/或开胸术。然而，这种入路无法对血管神经结构进行适当的控制。因此，我们介绍一种改良的“活板门”开胸术的经验，该方法能为儿科患者提供进入该区域的最佳途径。
我们报告了4例年龄为2.8±1.9岁的患者，在我院接受经胸骨柄的颈胸切开术，未发生锁骨脱位。1例患者为IV期颈胸神经母细胞瘤，1例为颈胸淋巴管瘤，1例为严重的颈胸脊柱侧弯，1例为完全性环状软骨闭锁合并IIIc型食管闭锁（Vogt型）。这种手术入路能够完美地控制头臂和神经结构，并能正确地观察到所有颈胸椎间孔。术后疼痛通过硬膜外导管控制，术后第5天开始口服镇痛治疗。
所有患者均可行完全切除及手术治疗，无需切断任何血管或神经结构。术中及术后均无并发症。1例患者出现暂时性霍纳综合征。平均随访2.3±3.1年，未见肿瘤复发。结论：改良的“活板门”入路能够很好地控制头臂结构，并能完整地观察到上胸部和后纵隔。由于其低发病率，这种入路可能非常有用，因为它允许重要的血管控制和良好的手术视野。我们对“活板门”入路的改良避免了锁骨脱位，并且具有不影响肩肱关节功能的优点。
