Shandong First Medical University (Shandong Academy of Medical Sciences), 6699 Qingdao Road, Jinan, Shandong, 250000, China.
Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, Shandong Province, 250021, China.
J Cardiothorac Surg. 2024 Oct 4;19(1):589. doi: 10.1186/s13019-024-03050-w.
Large mediastinum tumors invading the thoracic outlet have consistently been a challenge in thoracic surgery. Due to the large size of the tumor and its proximity to many important tissues, appropriate surgical approaches are crucial for a successful surgery.
Here, we present a case of a large neurilemmoma that invaded the thoracic outlet that was resected by a supraclavicular-median sternotomy approach. The case was a 58-year-old woman with a large mass in the right chest cavity that had invaded the thoracic outlet. The preoperative biopsy showed a blood clot with a few fibrous connective tissues covered by a single layer of flat epithelium. There was insufficient evidence to diagnose the mass as a tumor, and imaging examinations suggested a diagnosis of solitary pleural fibroma. For good exposure of the cranial and caudal aspects of the large mass, we devised a median sternotomy combined with a supraclavicular approach and safely achieved complete resection. The patient recovered well and experienced no severe complications or functional restrictions of the upper extremity. The postoperative pathology diagnosis was a neurilemmoma.
The supraclavicular-median sternotomy approach could be an optional approach for the complete resection of large mediastinal tumors invading the thoracic outlet.
侵犯胸廓出口的大纵隔肿瘤一直是胸外科的挑战。由于肿瘤体积大且靠近许多重要组织，因此适当的手术方法对于手术的成功至关重要。
我们在此报告一例侵犯胸廓出口的大型神经鞘瘤，采用锁骨上正中劈开胸骨入路切除。该病例为 58 岁女性，右侧胸腔内有一个大肿块，侵犯胸廓出口。术前活检显示有一个血凝块，其表面有少量纤维结缔组织，被单层扁平上皮覆盖。没有足够的证据将肿块诊断为肿瘤，影像学检查提示孤立性胸膜纤维瘤的诊断。为了充分暴露大肿块的颅侧和尾侧，我们设计了一种锁骨上正中劈开胸骨入路，并安全地实现了完全切除。患者恢复良好，无严重并发症或上肢功能受限。术后病理诊断为神经鞘瘤。
锁骨上正中劈开胸骨入路可作为完整切除侵犯胸廓出口的大纵隔肿瘤的一种可选方法。
