Azarow K S, Pearl R H, Zurcher R, Edwards F H, Cohen A J
Department of Thoracic Surgery, Walter Reed Army Medical Center, Washington, D.C. 20307-5001.
J Thorac Cardiovasc Surg. 1993 Jul;106(1):67-72.
Since 1944 62 pediatric patients with primary cysts and tumors of the mediastinum have been operated on at our institution. We compared this group with 195 adult patients with similar diagnoses who were operated on during this period. Comparisons were made with regard to histologic type, location, presenting symptoms, physical findings, and surgical complications. We found significant increases in the prevalence of lymphoma in adults (41/195 versus 4/62, p < 0.05) and of neurogenic tumors in children (21/62 versus 24/195, p < 0.05). There were no significant differences in the prevalence of thymic tumors (51/195 versus 22/62), germ cell tumors (24/195 versus 4/62), and cysts (32/195 versus 15/62). There was no difference in the prevalence of symptomatic patients (99/195 versus 36/62). The prevalence of malignancy has increased in both groups since 1970 (2/28 versus 16/34 in children, p < 0.01; and 14/56 versus 69/139 in adults, p < 0.05). This is attributed to a rise in the prevalence of malignant neurogenic tumors in children and to an increase in the prevalence of lymphomas in adults. Tumor size, location, and the presence of symptoms were predictive of malignancy in the adult population but not in the pediatric population. No difference existed in mortality and morbidity between the two groups. All three pediatric deaths were directly related to loss of airway control as a result of mass effect from the tumor. Definite differences exist between the adult and pediatric populations with regard to mediastinal tumors. These differences need to be considered carefully when evaluating and planning treatment for a child with a mediastinal mass.
自1944年以来，我院共对62例患有原发性纵隔囊肿和肿瘤的儿科患者进行了手术。我们将该组患者与同期接受手术的195例诊断相似的成年患者进行了比较。比较内容包括组织学类型、位置、临床表现、体格检查结果和手术并发症。我们发现，成人淋巴瘤的患病率显著增加（41/195对4/62，p<0.05），儿童神经源性肿瘤的患病率显著增加（21/62对24/195，p<0.05）。胸腺瘤（51/195对22/62）、生殖细胞瘤（24/195对4/62）和囊肿（32/195对15/62）的患病率无显著差异。有症状患者的患病率无差异（99/195对36/62）。自1970年以来，两组患者的恶性肿瘤患病率均有所增加（儿童为2/28对16/34，p<0.01；成人为14/56对69/139，p<0.05）。这归因于儿童恶性神经源性肿瘤患病率的上升和成人群体中淋巴瘤患病率的增加。肿瘤大小、位置和症状的存在可预测成年人群中的恶性肿瘤，但不能预测儿科人群中的恶性肿瘤。两组之间的死亡率和发病率无差异。3例儿科死亡均与肿瘤占位效应导致的气道控制丧失直接相关。在纵隔肿瘤方面，成人和儿科人群之间存在明显差异。在评估和规划纵隔肿物患儿的治疗时，需要仔细考虑这些差异。
