胸腔镜手术治疗儿童纵隔肿瘤经验总结OA北大核心
Clinical outcome of thoracoscopy for mediastinal tumors in children
目的 归纳分析各种儿童纵隔肿瘤的临床资料,总结儿童纵隔肿瘤的胸腔镜手术治疗经验.方法 回顾性分析2016年1月至2024年1月于四川省人民医院小儿外科就诊的纵隔肿瘤患儿临床资料,共纳入67例儿童纵隔肿瘤患者,其中男38例、女29例,年龄1岁5个月至13岁10个月(平均年龄8岁3个月).总结其肿瘤类型、临床表现、手术方式及预后情况.结果 本研究纳入的纵隔肿瘤类型包括:胸腺增生(n=23)、侵袭性胸腺瘤(n=3)、胸腺朗格汉斯细胞增生症(n=2)、神经母细胞瘤(n=10)、淋巴管瘤(n=8)、节细胞神经瘤(n=7)、神经纤维瘤(n=5)、畸胎瘤(n=3)、淋巴瘤(n=3)、支气管源性囊肿(n=2)、食管重复畸形(n=1).28例胸腺瘤及3例畸胎瘤位于前纵隔,3例淋巴瘤和2例支气管源性囊肿位于中纵隔,10例神经母细胞瘤、7例节细胞神经瘤、5例神经纤维瘤和1例食管重复畸形位于后纵隔.67例均行胸腔镜下纵隔肿瘤切除术,2例神经母细胞瘤无法完整切除,行活检术;其余65例均完整切除.住院治疗时间7～10 d,手术时间35～145 min(平均55 min),出血量10～50 mL(平均30 mL),留置胸腔引流管2～5 d,术后无一例发生伤口及胸腔内感染.术后5～8 d(平均6 d)出院.随访时间5～52个月(平均25个月);3例神经母细胞瘤患儿经综合治疗后死亡;2例神经母细胞瘤患儿术后复发继续化疗,目前生存良好;其余62例随访过程中均未见复发.结论 胸腔镜手术治疗儿童纵隔肿瘤安全可行,手术时间短,手术创伤小.术前CT对纵隔肿瘤的评估尤为重要,可大致判断肿瘤的性质及其与周围组织的关系,有助于手术方式的选择.
Objective To explore the clinical characteristics of mediastinal tumors and evaluate the effi-cacy and surgical techniques of thoracoscopy in children.Methods A retrospective analysis was conducted for the relevant clinical data of children with mediastinal tumors at Department of Pediatric Surgery,Sichuan People's Hospital,from January 2016 to January 2024.The study summarized tumor types,clinical manifesta-tions,surgical approaches and clinical outcomes.A total of 67 children with mediastinal tumors were recruited.There were 38 boys and 29 girls with a mean age range of 99(17-166)month.Results There were thymic hyperplasia(n=23),thymoma(n=3),Langerhans cell hyperplasia in thymus(n=2),neuroblastoma(n=10),lymphangioma(n=8),ganglionic neuroma(n=7),neurofibroma(n=5),teratoma(n=3),lymphoma(n=3),bronchogenic cyst(n=2)and esophageal duplicate malformation(n=1).Thymomas(n=8)and teratomas(n=3)were located in anterior mediastinum,lymphomas(n=3)and bronchogenic cysts(n=2)in mediastinum and the remainders in posterior mediastinum.Thoracoscopic resection of mediastinal tumor was performed.Four cases of neuroblastoma were converted into open surgery during operation.Two cases of incom-plete resection underwent biopsy.The remaining 65 children were completely resected.Average operative dura-tion was 55(35-145)min and average volume of blood loss 30(10-50)mL.Chest drainage tube was insert-ed for 2-5 days postoperatively.Hospitalization lasted for(7-10)day.Average time of hospital discharge was 6(5-8)day and average follow-up period 25(5-52)month.Three cases of neuroblastoma died after compre-hensive treatments,two cases of neuroblastoma recurred after surgery and continued chemotherapy and the re-mainders survived well.No wound or pleural infection occurred postoperatively.Conclusions Laparoscopy for mediastinal tumors in children is both safe and feasible with shorter operative duration and minimal trauma.Pre-operative CT imaging plays a crucial role in the assessment of mediastinal tumors.It provides detailed informa-tion regarding the nature of tumor and its relationship with surrounding structures.Such information is essential for optimizing surgical approaches.
马俊梅;蒋琴;何姿容;徐冰;刘文英
四川省医学科学院四川省人民医院电子科技大学附属医院儿童医学中心小儿外科,成都 610072四川省医学科学院四川省人民医院电子科技大学附属医院儿童医学中心小儿外科,成都 610072四川省医学科学院四川省人民医院电子科技大学附属医院儿童医学中心小儿外科,成都 610072四川省医学科学院四川省人民医院电子科技大学附属医院儿童医学中心小儿外科,成都 610072四川大学华西第二医院小儿外科,成都 610041
纵隔肿瘤胸腔镜检查外科手术儿童
Mediastinal TumorThoracoscopySurgical Procedures,OperativeChild
《临床小儿外科杂志》 2025 (5)
410-414,5
四川省科技厅重点项目(2021YFS0381)成都市科技局课题(2024-YF05-01871-SN) Key Project of Sichuan Provincial Department of Science and Technology(2021YFS0381)Project of Chengdu Municipal Science and Technology Bureau(2024-YF05-01871-SN)
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