Ferguson M K, Lee E, Skinner D B, Little A G
Department of Surgery, University of Chicago Medical Center, IL 60637.
Ann Thorac Surg. 1987 Dec;44(6):583-6. doi: 10.1016/s0003-4975(10)62139-x.
We retrospectively reviewed the records of 41 patients with an isolated anterior mediastinal mass to identify whether the traditional surgical approach of resection for both diagnosis and therapy is the optimal approach to these tumors. In addition to plain chest radiographs, clinical evaluation included computed tomography (CT) in 23 and gallium scintigraphy in 23. The initial intervention was attempted excisional therapy in 16 and mediastinoscopy for biopsy in 25. Pathological diagnoses included lymphoma (13), thymoma (11), germ cell tumor (6), carcinoid (2), bronchogenic carcinoma (2), and other benign processes (7). Based on histological findings, nonoperative therapy was the most appropriate treatment in 61%. The clinical selection of the surgical approach was not aided by patient age, symptoms, or findings on CT. The gallium scan was positive in 13 of 15 patients for whom nonoperative therapy was appropriate, and was normal in 7 of 8 for whom excision was indicated. Mediastinoscopy is useful in the diagnosis of anterior mediastinal masses, and may eliminate unnecessary thoracotomy, especially when a gallium scan is positive.
我们回顾性分析了41例孤立性前纵隔肿块患者的病历，以确定传统的手术切除诊断兼治疗方法是否为这些肿瘤的最佳治疗方法。除胸部X线平片外，临床评估包括23例行计算机断层扫描（CT）和23例行镓扫描。16例患者首先尝试了切除治疗，25例行纵隔镜活检。病理诊断包括淋巴瘤（13例）、胸腺瘤（11例）、生殖细胞瘤（6例）、类癌（2例）、支气管源性癌（2例）及其他良性病变（7例）。根据组织学检查结果，61%的患者最适合非手术治疗。患者年龄、症状或CT检查结果无助于手术方式的临床选择。15例适合非手术治疗的患者中，13例镓扫描呈阳性，8例适合手术切除的患者中，7例镓扫描正常。纵隔镜检查对前纵隔肿块的诊断有用，尤其当镓扫描呈阳性时，可避免不必要的开胸手术。
