King D R, Patrick L E, Ginn-Pease M E, McCoy K S, Klopfenstein K
Department of Surgery, Ohio State University College of Medicine, Columbus, USA.
J Pediatr Surg. 1997 Feb;32(2):294-9; discussion 299-300. doi: 10.1016/s0022-3468(97)90197-4.
Lymphomas account for nearly 20% of the malignancies in childhood and the majority of patients with Hodgkin's Disease (HD) and non-Hodgkin's lymphoma (NHL) have radiological evidence of mediastinal involvement at presentation. Children with mediastinal tumors are at risk for the development of lethal airway obstruction during general anesthesia. This study quantitates the degree of the airway obstruction and the functional significance of tracheal compression in a cohort of 51 children with HD and NHL.
Thirty patients with HD (mean age, 14.6 years) and 21 with NHL (mean age, 9.2 years) were included in this study. Twenty-five children (49%) had respiratory symptoms at the time of presentation. Respiratory complaints were much more common in children with NHL (76%) when compared with those with HD (30%). Pulmonary function was also significantly worse in the NHL patients who had a mean upright forced vital capacity (FVC) of 66 +/- 21%. The comparable value for the children with HD was 85 +/- 15% (P = .031). Patients with respiratory symptoms at presentation had both obstructive and restrictive deficits of pulmonary function. Their mean upright forced expiratory volume in 1 second (FEV1) was 69 +/- 22% and the FVC was 69 +/- 18%. Children with large mediastinal masses also had significantly decreased pulmonary function compared with those with small tumors. The upright FEV1 for these two groups was 72 +/- 18% versus 98 +/- 15% (P = .016). Their FVC values were 68 +/- 20% and 91 +/- 17%, respectively (P = .049). Mean tracheal compression was measured at 44% in the children with large tumors versus 27% for those with small lesions (P = .048).
Children with mediastinal lymphomas have both obstructive and restrictive deficits on pulmonary function testing. Pulmonary function is significantly decreased in patients with NHL, children who present with respiratory symptoms, and those with very large mediastinal masses (mediastinal mass ratio > 45%). The extent of tracheal compression correlates with the size of the mediastinal mass.
淋巴瘤占儿童恶性肿瘤的近20%，大多数霍奇金病（HD）和非霍奇金淋巴瘤（NHL）患者在初诊时影像学检查有纵隔受累证据。纵隔肿瘤患儿在全身麻醉期间有发生致命性气道梗阻的风险。本研究对51例HD和NHL患儿的气道梗阻程度及气管受压的功能意义进行了定量分析。
本研究纳入了30例HD患儿（平均年龄14.6岁）和21例NHL患儿（平均年龄9.2岁）。25例患儿（49%）在初诊时有呼吸道症状。与HD患儿（30%）相比，NHL患儿的呼吸道症状更为常见（76%）。NHL患儿的肺功能也明显较差，其平均直立位用力肺活量（FVC）为66±21%。HD患儿的相应值为85±15%（P = 0.031）。初诊时有呼吸道症状的患者存在阻塞性和限制性肺功能缺陷。他们的平均直立位1秒用力呼气量（FEV1）为69±22%，FVC为69±18%。与小肿瘤患儿相比，纵隔大肿块患儿的肺功能也明显下降。这两组患儿的直立位FEV1分别为72±18%和98±15%（P = 0.016）。他们的FVC值分别为68±20%和91±17%（P = 0.049）。大肿瘤患儿的平均气管受压率为44%，小病变患儿为27%（P = 0.048）。
纵隔淋巴瘤患儿在肺功能测试中存在阻塞性和限制性缺陷。NHL患者、有呼吸道症状的患儿以及纵隔肿块非常大（纵隔肿块比例>45%）的患儿肺功能明显下降。气管受压程度与纵隔肿块大小相关。
