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目的 总结累及心脏大血管的复杂纵隔肿瘤外科处理原则.方法 回顾性分析1997年2月至2014年5月38例累及心脏大血管的复杂纵隔肿瘤的围术期处理情况.男26例,女12例,年龄4～ 68(41.3±13.6)岁.采取多种个性化切除重建术式,部分患者综合采用两种或以上的技术,总计行右房部分切除3例,大血管切除、成形、置换16例,心包部分切除修补10例,肺楔形切除8例,肺叶切除2例;其中2例在体外循环下进行.结果 所有患者均顺利完成手术,无围术期死亡,手术时间105 ～ 282min,出血量200～1 500ml,术后平均住院时间11.2 d,ICU住院率47.4％,ICU平均住院时间1.8 d.并发症发生率23.7％,5年生存率57.0％.结论 累及心脏大血管的复杂纵隔肿瘤手术难度及危险性较大,只要做好充分的围术期准备,采取适当术式,可安全顺利完成手术并达到理想的治疗效果.“,”Objective To summarize the surgical management of complicated mediastinal tumor involving the heart or great vessels.Methods We retrospectively analyzed the clinical data of 38 patients with complicated mediastinal tumor invading the heart and large blood vessels underwent extended thymectomy in our hospital between February 1997 and May 2014.There were 26 males and 12 females at age of 41.3±13.6 years ranking from 4 to 68 years.Multiple personalized procedures were applied within the 38 patients and some patients underwent more than one procedure.Besides the resection of mediastinal tumor,3 patients underwent partial right atrial resection.Sixteen patients underwent resection,plasty or grafting vessels.Ten patients took partial excision and repair of pericardium.Eight patients underwent pulmonary wedge resection.Two patients underwent lobectomy.Two patients required cardiopulmonary bypass.Result All operations were completed successfully.There was no perioperative mortality.The operating time was 105-282 rmin and blood loss was 200-1 500 ml.The postoperative complications rate was 23.7％.The incidence of ICU admission was 47.4％ with an average ICU stay of 1.8 days.The average length of post-operative hospital stay was 11.2 days.The five-year survival rate was 57.0％.Conclusion Surgical resection of mediastinal tumor invading the heart or great vessels is complicated and highly risky.However,desirable clinical outcome can be achieved with comprehensive perioperative assessment and appropriate surgical procedures.