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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:
引用本文:

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/OL]. 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/OL]. 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。

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.

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
1
Cohen DJ, Ronnigen LD, Graeber GM, et al. Management of patients with malignant thymoma[J]. J Thorac Cardiovasc Surg, 1984, 87(2): 301-307.
2
Pastorino U, Yang XN, Francese M, et al. Long-term survival after salvage surgery for invasive thymoma with intracardiac extension[J]. Tumori, 2007, 94(5): 772-776.
3
Engels EA, Pfeiffer RM. Malignant thymoma in the United States: demographic patterns in incidence and associations with subsequent malignancies[J]. Int J Cancer, 2003, 105(4): 546-551.
4
Müller-Hermelink HK, Engel P, et al. Pathology & genetics, tumours of the lung, pleura, thymus and heart. World Health Organization Classification of Tumors[M]. Lyon: IARC Press, 2004: 146-147.
5
Marx A, Str?bel P, Badve SS, et al. ITMIG consensus statement on the use of the WHO histological classification of thymoma and thymic carcinoma: refined definitions, histological criteria, and reporting[J]. J Thorac Oncol, 2014, 9(5): 596-611.
6
Leo F, Bellini R, Conti B, et al. Superior vena cava resection in thoracic malignancies: does prosthetic replacement pose a higher risk?[J]. Eur J Cardiothorac Surg, 2010, 37(4): 764-769.
7
Arvind K, Roman D, Umashankkar K, et al. Resection and reconstruction of mediastinal great vessels in invasive thymoma[J]. Indian J Cancer, 2010, 47(4): 400.
8
Large SR, Shneerson JM, Stovin PG, et al. Surgical pathology of the thymus: 20 years’ experience. Thorax, 1986, 41(1): 51-54.
9
Konstantinov IE, Saxena P, Koniuszko M, et al. Superior vena cava obstruction by tumour thrombus in invasive thymoma: diagnosis and surgical management[J]. Heart Lung Circ, 2007, 16(6): 462-464.
10
Rosa GRS, Takizawa N, Schimidt D, et al. Surgical treatment of superior vena cava syndrome caused by invasive thymoma[J]. Rev Bras Cir Cardiovasc, 2010, 25(2): 257-260.
11
Kamikubo Y, Shiiya N, Kubota S, et al. Thymic carcinoma with tumor thrombus into the superior vena cava[J]. Jpn J Thorac Cardiovasc Surg, 2001, 49(5): 327-329.
12
Yagi K, Hirata T, Fukuse T, et al. Surgical treatment for invasive thymoma, especially when the superior vena cava is invaded[J]. Ann Thorac Surg, 1996, 61(2): 521-524.
13
Politi L, Crisci C, Montinaro F, et al. Prosthetic replacement and tangential resection of the superior vena cava in chest tumors[J]. J Cardiovasc Surg (Torino), 2007, 48(3): 363.
14
Chen KN, Xu SF, Gu ZD, et al. Surgical treatment of complex malignant anterior mediastinal tumors invading the superior vena cava[J]. World J Surg, 2006, 30(2): 162-170.
15
Spaggiari L, Magdeleinat P, Kondo H, et al. Results of superior vena cava resection for lung cancer: analysis of prognostic factors[J]. Lung Cancer, 2004, 44(3): 339-346.
16
Warren WH, Piccione WJ, Faber LP. As originally published in 1990: superior vena caval reconstruction using autologous pericardium[J]. Ann Thorac Surg, 1998, 66(1): 291-292.
17
Lü WD, Yu FL, Wu ZS. Superior vena cava reconstruction using bovine jugular vein conduit[J]. Eur J Cardiothorac Surg, 2007, 32(5): 816-817.
18
Doty JR, Flores JH, Doty DB. Superior vena cava obstruction: bypass using spiral vein graft[J]. Ann Thorac Surg, 1999, 67(4): 1111-1116.
19
Schoof PH, Koch AD, Hazekamp MG, et al. Bovine jugular vein thrombosis in the Fontan circulation[J]. J Thorac Cardiovasc Surg, 2002, 124(5): 1038-1040.
20
Amirghofran AA, Emaminia A, Rayatpisheh S, et al. Intracardiac invasive thymoma presenting as superior vena cava syndrome[J]. Ann Thorac Surg, 2009, 87(5): 1616-1618.
21
Van Putten JWG, Schlosser NJJ, Vujaskovic Z, et al. Superior vena cava obstruction caused by radiation induced venous fibrosis[J]. Thorax, 2000, 55(3): 245-246.
22
Spaggiari L, Thomas P, Magdeleinat P, et al. Superior vena cava resection with prosthetic replacement for non-small cell lung cancer: long-term results of a multicentric study[J]. Eur J Cardiothorac Surg, 2002, 21(6): 1080-1086.
23
Garcia-Rinaldi R, Zamora JL, Torres-Salichs M, et al. Four-year patency of PTFE grafts after replacement of the superior vena cava and the innominate veins[J]. Tex Heart Inst J, 1988, 15(3): 192.
24
Nonaka T, Tamaki Y, Higuchi K, et al. The role of radiotherapy for thymic carcinoma[J]. Jpn J Clin Oncol, 2004, 34(12): 722-726.
25
Yokoi K, Miyazawa N, Mori K, et al. Invasive thymoma with intracaval growth into the right atrium[J]. Ann Thorac Surg, 1992, 53(3): 507-509.
26
Ogawa K, Toita T, Uno T, et al. Treatment and prognosis of thymic carcinoma[J]. Cancer, 2002, 94(12): 3115-3119.
27
Graeber GM, Tamim W. Current status of the diagnosis and treatment of thymoma[J]. Semin Thorac Cardiovasc Surg, 2000, 12(4): 268-277.
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