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目的总结老年性巨大纵隔肿瘤的手术治疗效果。方法回顾性分析2008年1月至2013年5月扬州大学临床医学院苏北人民医院12例年龄大于60岁行巨大纵隔肿瘤手术治疗的老年患者,男7例、女5例,年龄60~71(64.2±3.4)岁。手术全部切除11例,姑息性切除1例,其中肺叶切除2例,部分心包切除2例。结果全组无手术死亡病例。术后病理诊断:脂肪瘤1例,胸骨后甲状腺瘤2例,纵隔囊肿3例,胸腺瘤2例,神经鞘瘤1例,腺鳞癌1例,鳞癌1例,孤立性纤维性肿瘤1例。术中并发大出血1例,术后并发复张性肺水肿2例,予以对症治疗后痊愈。随访3个月至5年,1例失访。1例因肿瘤转移死亡,1例死于其它疾病;余9例随访均健康,生活质量良好。结论手术治疗老年性巨大纵隔肿瘤效果好。术前应充分做好准备,术中防止低血压、心脏压迫,控制致命性出血,术后积极防治复张性肺水肿。
Objective To summarize the surgical treatment of giant mediastinal tumors of the elderly. Methods From January 2008 to May 2013, 12 elderly patients with giant mediastinal tumors older than 60 years who underwent surgery at North Jiangsu People’s Hospital of Yangzhou University from January 2008 to May 2013 were retrospectively analyzed. There were 7 males and 5 females, aged 60-71 (64.2 ± 3.4) years old. Surgical resection in 11 cases, palliative resection in 1 case, including lobectomy in 2 cases, partial pericardial resection in 2 cases. Results The whole group of patients without surgical death. Postoperative pathological diagnosis: lipoma in 1 case, sternum thyroid tumor in 2 cases, mediastinal cyst in 3 cases, thymoma in 2 cases, schwannoma in 1 case, adenosquamous carcinoma in 1 case, squamous cell carcinoma in 1 case, solitary fibrous tumor 1 example. Intraoperative bleeding in 1 case complicated by recurrent pulmonary edema in 2 cases, to be cured after symptomatic treatment. Follow-up 3 months to 5 years, 1 case lost. One patient died of tumor metastasis and one patient died of other diseases. All the other nine patients were followed up for good quality of life. Conclusion Surgical treatment of giant mediastinal tumors of good effect. Preoperative preparation should be fully, intraoperative prevention of hypotension, cardiac compression, control of fatal bleeding, postoperative prevention and treatment of rectal pulmonary edema.