Chikaishi Yasuhiro, Matsumiya Hiroki, Kanayama Masatoshi, Taira Akihiro, Nabe Yusuke, Shinohara Shinji, Kuwata Taiji, Takenaka Masaru, Oka Soichi, Hirai Ayako, Kuroda Koji, Imanishi Naoko, Ichiki Yoshinobu, Nishimura Yosuke, Tanaka Fumihiro
Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health (UOEH), 1-1 Isecigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
Department of Cardiovascular Surgery, School of Medicine, University of Occupational and Environmental Health (UOEH), 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
Ann Med Surg (Lond). 2018 Sep 25;35:82-85. doi: 10.1016/j.amsu.2018.09.023. eCollection 2018 Nov.
Patients with undiagnosed anterior mediastinal tumors commonly undergo surgery for diagnosis and treatment. However, determining the optimal therapeutic strategy is difficult for tumors with substantial invasion, such as lesions touching the aortic arch (AA).
A 76-year-old man of Asian descent presented to our hospital because chest computed tomography (CT) revealed an anterior mediastinal tumor. This tumor surrounded the left subclavian vein and touched the AA. We suspected the tumor to be malignant. We therefore decided to resect the tumor with preparation for total arch replacement (TAR). The operation was performed in three steps. First, we performed a mediastinal sternotomy. However, the tumor had invaded the subclavian vein, so we resected this vein after adding a transmanubrial approach. However, because of invading the AA we needed next step. Second, we shifted the patient to the right lateral decubitus position. We performed partial resection of the left upper lobe and exfoliated the distal AA. Third, we shifted the patient to the dorsal position and implanted an artificial cardiopulmonary device, after which we performed TAR, and pulmonary artery (PA) trunk plasty with a pericardial patch. The operation was successful, with no major adverse events. Pathologically, the tumor was diagnosed as diffuse large B-cell lymphoma.
If oncologically complete resection is preferable for tumors with substantial invasion, complete resection should be attempted even if the surgery is difficult.
We performed complete resection of an anterior mediastinal tumor with TAR and PA trunk plasty using a pericardial patch.
未确诊的前纵隔肿瘤患者通常需接受手术以明确诊断并进行治疗。然而，对于具有广泛浸润的肿瘤，如累及主动脉弓（AA）的病变，确定最佳治疗策略颇具难度。
一名76岁亚裔男性因胸部计算机断层扫描（CT）显示前纵隔肿瘤而就诊于我院。该肿瘤包绕左锁骨下静脉并累及主动脉弓。我们怀疑该肿瘤为恶性。因此，我们决定在准备行全弓置换术（TAR）的情况下切除肿瘤。手术分三步进行。首先，我们进行了纵隔胸骨切开术。然而，肿瘤已侵犯锁骨下静脉，因此我们在增加经胸骨上入路后切除了该静脉。但由于肿瘤侵犯主动脉弓，我们需要进行下一步操作。其次，我们将患者转为右侧卧位。我们切除了左肺上叶的部分组织并游离了主动脉弓远端。第三步，我们将患者转为仰卧位并植入人工心肺装置，之后进行了全弓置换术以及用心包补片进行肺动脉干成形术。手术成功，未发生重大不良事件。病理检查显示，该肿瘤被诊断为弥漫性大B细胞淋巴瘤。
如果对于广泛浸润的肿瘤，肿瘤学上的完整切除更为可取，那么即使手术困难，也应尝试进行完整切除。
我们通过全弓置换术和用心包补片进行肺动脉干成形术，成功完整切除了前纵隔肿瘤。
