Department of Surgery, Pediatric Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
J Pediatr Surg. 2014 Jan;49(1):172-6; discussion 176-7. doi: 10.1016/j.jpedsurg.2013.09.049. Epub 2013 Oct 5.
BACKGROUND/PURPOSE: For pediatric tumors of the cervicothoracic junction, an isolated cervical or thoracic surgical approach provides insufficient exposure for achieving complete resection. We retrospectively examined "trap-door" and "clamshell" pediatric thoracotomies as a surgical approach to these tumors.
We searched our database for pediatric patients with cervicothoracic tumors who underwent clamshell or trap-door thoracotomy between 1991 and 2013, reviewing tumor characteristics, surgical technique, completeness of resection, morbidity, and outcome.
Trap-door (n=13) and clamshell (n=4) thoracotomies were performed for neuroblastoma (n=9), non-rhabdomyosarcoma soft tissue sarcoma (n=4), germ cell tumor (n=2), rhabdomyosarcoma (n=1), and neuroendocrine small cell carcinoma (n=1). Fourteen of these cervicothoracic tumors were primary, and three were metastatic. Gross total resection was achieved in 15 patients (94%). Operative complications included vocal cord paralysis (n=2), mild upper-extremity neuropraxia (n=2), and hemidiaphragm paralysis (n=1), All but one involved encased nerves. Overall survival was 61% for the series and 80% for patients with primary tumors. Eleven (73%) of 15 patients who underwent gross total resection had no evidence of recurrence. Three patients with metastatic disease died of distant progression within 1.3years.
Gross total resection of primary cervicothoracic tumors can be accomplished with specialized exposure in pediatric patients with minimal morbidity.
背景/目的：对于颈胸交界处的小儿肿瘤，单独的颈部或胸部手术方法提供的暴露不足以实现完全切除。我们回顾性研究了“活门”和“蛤壳”小儿开胸术作为治疗这些肿瘤的一种手术方法。
我们在数据库中搜索了 1991 年至 2013 年间接受蛤壳或活门开胸术的颈胸交界部肿瘤患儿的资料，回顾了肿瘤特征、手术技术、切除的完整性、发病率和结果。
活门（n=13）和蛤壳（n=4）开胸术用于神经母细胞瘤（n=9）、非横纹肌肉瘤软组织肉瘤（n=4）、生殖细胞肿瘤（n=2）、横纹肌肉瘤（n=1）和神经内分泌小细胞癌（n=1）。这些颈胸交界部肿瘤中有 14 个为原发性，3 个为转移性。15 例患者达到了大体全切除（94%）。手术并发症包括声带麻痹（n=2）、轻度上肢神经病变（n=2）和膈肌麻痹（n=1），除 1 例外均涉及被包裹的神经。该系列的总生存率为 61%，原发性肿瘤患者的生存率为 80%。15 例接受大体全切除的患者中，有 11 例（73%）无复发证据。3 例转移性疾病患者在 1.3 年内死于远处进展。
对于小儿患者，采用特殊的暴露方法可以实现原发性颈胸交界部肿瘤的大体全切除，且发病率低。
