Abstract: Objective To explore the surgical diagnosis and treatment methods and experience of giant anterior superior mediastinal tumors. Methods Through the retrospective analysis of 34 cases of giant anterior superior mediastinal tumors admitted to our hospital from 2013 to 2018, among them 13 cases underwent lateral anterolateral incision + sternal cross-split incision, and 21 cases underwent median thoracotomy. The surgical diagnosis and treatment methods of giant anterior superior mediastinal tumors were discussed. Results Thirty-four cases of giant anterior superior mediastinal tumors were surgically removed: 13 cases underwent lateral anterolateral incision + sternal cross-split incision, there were 12 (92.3%) cases of radical resection and 1 case of palliative resection; 21 cases underwent median thoracotomy, there were 18 (85.7%) cases of radical resection and 3 cases of palliative resection. In 34 cases, there were 3 cases of thymic squamous cell carcinoma, 1 case of highly aggressive B-cell lymphoma-diffuse large B-cell lymphoma, 14 cases of thymoma, 3 cases of sarcoma, 7 cases of mature teratoma, 3 cases of solitary fibrous tumor, 2 cases of seminoma, and 1 case of goiter. The operation time and blood loss of lateral anterolateral incision + sternal cross-split incision group were greater than those of the median thoracotomy group (both P<0.05), there was no statistically significant difference in the maximum tumor diameter between the two groups (P>0.05). However, for giant anterior superior mediastinal tumors those were close to the posterior wall of the sternum with invaded lung tissue, lateral anterolateral incision on the main body of the tumor + sternal cross-split incision could be used as a surgical incision and the surgical field was safer. Conclusion Surgery is the preferred treatment method for giant anterior superior mediastinal tumors. Preoperative enhanced CT has an important reference value for the surgical method and risk assessment, and the choice of surgical incision has an important auxiliary effect on the success of surgery.

Key words: Giant anterior superior mediastinal tumors, Anterior mediastinal tumors, Surgical incision, Surgery

摘要： 目的 探讨巨大前上纵隔肿瘤的外科诊疗手段及经验。方法 通过对本院2013—2018年收治的34例巨大前上纵隔肿瘤临床病例进行回顾性分析,13例患者行肿瘤偏向侧前外侧切口+胸骨横劈切口,21例患者行正中开胸手术,比较两组患者不同手术切口的手术指标(肿瘤最大直径、手术时间及出血量)。结果 34例巨大前上纵隔肿瘤患者均进行了手术切除:13例患者行肿瘤偏向侧前外侧切口+胸骨横劈切口手术,根治性切除12例,姑息性切除1例,根治性切除率为92.3%;21例患者行正中开胸手术,其中根治性切除18例,姑息性切除3例,根治性切除率为85.7%。34例患者中胸腺鳞癌3例,高侵袭性B细胞淋巴瘤-弥漫大B细胞淋巴瘤1例,胸腺瘤14例,肉瘤3例,成熟畸胎瘤7例,孤立性纤维性肿瘤3例,精原细胞瘤2例,甲状腺肿1例。前外侧切口+胸骨横劈切口组患者手术时间及出血量均大于正中开胸组(均P<0.05),肿瘤最大直径两组间比较差异无统计学意义(P>0.05)。但对于与胸骨后壁紧密、肺组织受侵犯的巨大前上纵隔肿瘤,肿瘤主体偏向侧行前外侧切口+胸骨横劈切口可作为手术切口手术视野和安全性更高。结论 手术是巨大前上纵隔肿瘤首选治疗方法,术前增强CT对于手术方式及风险评估有重要参考价值,手术切口的选择对手术成功有重要辅助性作用。

关键词: 巨大前上纵隔肿瘤, 前纵隔肿瘤, 手术切口, 外科