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目的 探讨颈胸联合部肿瘤外科治疗的手术方法及要点。方法 14例颈胸联合部肿瘤施行手术。经颈正中加胸骨正中切口 4例 ,颈正中、胸骨次全劈开、前胸外侧联合切口 (半蛤壳切口 ) 10例。肿瘤完全切除 11例 ,姑息性减状切除 3例。结果 全组无手术死亡 ,1例原始神经外胚层瘤术后 18个月、2 6个月分别转移至右肺尖、心包 ,已行二次、三次手术。随访 4～ 72月 ,晚期死亡 3例 ,死于肿瘤复发。结论 颈胸联合部肿瘤组织来源呈多样化 ,以神经源性肿瘤多见 ;一经确诊应争取手术治疗 ;半蛤壳切口创伤稍大 ,但术野清晰 ,利于防止副损伤 ;术中注意气管的悬吊复位 ,利于保持气管通畅。
Objective To investigate the surgical methods and key points of surgical treatment of tumor in the neck and thoracic junction. Methods Twenty - four patients with neck and thoracic tumor underwent surgery. The middle of the neck plus the median incision in the sternum in 4 cases, the middle neck, sternum all split, lateral thoracotomy (clam shell incision) in 10 cases. Tumor resection in 11 cases, palliative resection in 3 cases. Results All the patients died without surgery. One patient with primitive neuroectodermal tumor was transferred to the right apical and pericardium at 18 months and 26 months after operation respectively. The second and third surgeries were performed. Followed up from 4 to 72 months, 3 died in late stage and died of tumor recurrence. Conclusion The sources of tumor tissue in cervical-thoracic and thoracic joint are diversified, with neurogenic tumors more common; once diagnosed, surgery should be strived; the wounds of the clam shell incision are slightly larger, but the operative field is clear, which will help to prevent the secondary injury; Suspension reset, help maintain tracheal patency.