Chen Xiaofeng, Ma Qinyun, Wang Shaohua, Zhang Huijun, Huang Dayu
Department of Cardiothoracic Surgery, Huashan Hospital, Fudan University, Shanghai, China.
J Surg Oncol. 2019 May;119(6):807-813. doi: 10.1002/jso.25381. Epub 2019 Jan 17.
Posterior mediastinal neurogenic tumors are among the most frequent mediastinal masses in adults. These tumors may be dumbbell shaped, extending into the spinal canal, exclusively paraspinal or apical tumors extending in the cervical region. In this report, we present our experience in the surgical resection of these tumors and discuss the surgical strategies for such tumors.
A retrospective analysis was performed of 121 patients who underwent surgery for posterior mediastinal neurogenic tumors at our department during the period 2009 to 2016. Seventy-four tumors were excised via video-assisted thoracic surgery (VATS). Other approaches included thoracotomy, supraclavicular incision, supraclavicular incision plus thoracotomy/VATS, and a posterior approach with laminectomy combined with thoracotomy/VATS.
Tumors were resected completely in 119 cases and partially in two. The majority of the tumors were benign nerve sheath tumors. No recurrence developed during postoperative median follow-up period of 31 months.
Most posterior neurogenic tumors can be resected via VATS. Thoracotomy is the appropriate surgical approach for large tumors. A supraclavicular approach is recommended for tumors extending in the cervical region, and this can be combined with VATS or thoracotomy in case of larger masses. A posterior approach could be used for patients with dumbbell tumors.
后纵隔神经源性肿瘤是成人中最常见的纵隔肿物之一。这些肿瘤可能呈哑铃形，延伸至椎管内，也可能仅是椎旁肿瘤或延伸至颈部的顶叶肿瘤。在本报告中，我们介绍了我们在这些肿瘤手术切除方面的经验，并讨论了此类肿瘤的手术策略。
对2009年至2016年期间在我科接受后纵隔神经源性肿瘤手术的121例患者进行回顾性分析。74例肿瘤通过电视辅助胸腔镜手术（VATS）切除。其他手术入路包括开胸手术、锁骨上切口、锁骨上切口加开胸手术/VATS，以及后路椎板切除术联合开胸手术/VATS。
119例患者肿瘤完全切除，2例部分切除。大多数肿瘤为良性神经鞘瘤。术后中位随访31个月期间无复发。
大多数后纵隔神经源性肿瘤可通过VATS切除。开胸手术是治疗大型肿瘤的合适手术方法。对于延伸至颈部的肿瘤，建议采用锁骨上入路，对于较大肿物，可联合VATS或开胸手术。对于哑铃形肿瘤患者，可采用后路入路。
