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中华胸部外科电子杂志

中华胸部外科电子杂志 ›› 2017, Vol. 04 ›› Issue (04) : 228 -233. doi: 10.3877/cma.j.issn.2095-8773.2017.04.07

所属专题： 文献；

论著

外科治疗36例侵袭性胸腺瘤伴血管置换的临床经验
傅世杰1, 顾畅1, 潘旭峰1, 赵珩1, 方文涛1, 杨骏1,†()   
  1. 1. 200030　上海交通大学附属胸科医院胸外科
  • 收稿日期:2017-09-10 出版日期:2017-11-28
  • 通信作者: 杨骏

A retrospective study of 36 cases with reconstruction of mediastinal vessels for invasive thymoma

Shijie Fu1, Chang Gu1, Xufeng Pan1, Heng Zhao1, Wentao Fang1, Jun Yang1,†()   

  1. 1. Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao tong University, Shanghai 200030, China
  • Received:2017-09-10 Published:2017-11-28
  • Corresponding author: Jun Yang
  • About author:
    Corresponding author: Yang Jun, Email:
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傅世杰, 顾畅, 潘旭峰, 赵珩, 方文涛, 杨骏. 外科治疗36例侵袭性胸腺瘤伴血管置换的临床经验[J]. 中华胸部外科电子杂志, 2017, 04(04): 228-233.

Shijie Fu, Chang Gu, Xufeng Pan, Heng Zhao, Wentao Fang, Jun Yang. A retrospective study of 36 cases with reconstruction of mediastinal vessels for invasive thymoma[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2017, 04(04): 228-233.

目的

探讨累及纵隔大血管侵袭性胸腺瘤的外科治疗方式及其术后疗效。

方法

2007年4月—2017年4月，上海市胸科医院共收治累及纵隔大血管侵袭性胸腺瘤患者36例，对患者的临床资料、手术方式、辅助放化疗以及随访情况进行分析。

结果

全组患者手术顺利，无术中或院内死亡病例，29例(81%)患者的肿瘤被完全切除。14例患者行单纯上腔静脉置换；10例患者行左无名静脉—右心耳搭桥；3例患者行右无名静脉—右心耳搭桥；2例患者行左无名静脉—右心耳搭桥＋上腔静脉切除，其余患者均行复杂血管置换手术(>1根血管桥)。共10例(27.8%)患者术后发生并发症，其中肺部感染5例，电解质紊乱2例，乳糜胸、肺不张、活动性出血二次手术开胸探查各1例。其余患者中，13例复发患者中10例在随访过程中死亡。患者3年和5年总生存率分别为79.1%和58.8%。与姑息切除组(n＝7)相比，完全切除组(n＝29)患者的预后更好，两组比较差异有统计学意义(Log-rank P ＝0.048)。

结论

侵袭性胸腺瘤累及纵隔大血管后行人工血管置换是可行的手术方式。完全切除肿瘤及其累及组织对提高手术疗效、改善患者预后至关重要。

关键词: 侵袭性胸腺瘤, 血管置换, 预后
Objective

To investigate the surgical treatment of invasive thymoma invading adjacent great vessels.

Methods

A retrospective study on 36 patients with invasive thymoma invading adjacent great vessels was performed. The corresponding data including clinical presentation, operation procedure, adjuvant radio-chemotherapy and follow-up were reviewed.

Results

All the patients were successfully operated without any intraoperative or hospital deaths. The tumors of 29 patients (81%) were completely resected. 14 patients underwent simple superior vena cava (SVC) reconstruction; 10 patients underwent left brachiocephalic vein (BCV) - right atrial appendage (RAA) reconstruction; 3 patients underwent right BCV - RAA reconstruction; 2 patients underwent left BCV-RAA reconstruction along with SVC resection; and other patients underwent complex vessel reconstruction (more than 1 vascular bridge). Ten patients (27.8%) had postoperative complications, including 5 cases of pulmonary infection, Two cases of electrolyte disturbance, 1 case of chylothorax, 1 case of atelectasis, and 1 case of haemothorax. Two patients died due to acute respiratory distress syndrome within 90 days after the surgery. Of the remaining patients, 13 cases (36%) experienced a relapse and finally 10 cases (27.8%) died. Compared to R1 resection group, R0 resection group had a better prognosis (P =0.048). The 3-year and 5-year survival rates were 79.1% and 58.8%, with median survival time of 84 months.

Conclusions

Reconstruction of mediastinal vessels for invasive thymoma is a feasible technology. Radical resection of the tumor with involved adjacent structures is the key to prolong overall survival for patients suffered from invasive thymoma.

Key words: Invasive thymoma, Vessel reconstruction, Prognosis
图1 36例胸腺瘤侵及纵隔血管(a)和血管置换(b)示意图。1.胸腺瘤侵及上腔静脉和左、右无名静脉(3例)；2.胸腺瘤侵及上腔静脉、右无名静脉(1例)；3.胸腺瘤侵及上腔静脉、左无名静脉(2例)；4.胸腺瘤侵及上腔静脉和左、右无名静脉(2例)；5.胸腺瘤侵及右颈总动脉、左无名静脉(1例)；6.胸腺瘤侵及右无名静脉(3例)；7.胸腺瘤侵及左无名静脉(10例)；8.胸腺瘤侵及上腔静脉(14例)
图2 36例侵袭性胸腺瘤累及上腔静脉大血管患者的生存情况。A. 3年总生存率为79.1%；B. 5年总生存率为58.8%
图3 姑息切除组(R1组)与完全切除组(R0组)患者总生存情况比较
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