摘要:目的:探讨晚期食管癌切除、纵隔淋巴结清扫及术中纵隔热灌注化疗对残留于气管、支气管、胸主动脉、奇静脉等器官的癌性肉眼微小病灶治疗效果。方法:选择食管癌病变浸润超过外膜层外侵至气管、支气管、胸主动脉、奇静脉等器官患者112例，随机分为两组:治疗组56例,术中42～43℃无菌蒸馏水2000～2500 mL加入顺铂(DDP)150 mg及氟尿嘧啶(5FU)1200 mg在体外循环下行纵隔热灌注化疗40 min;对照组56例,术中未进行纵隔热灌注化疗。结果:治疗组术后第一年有6例出现纵隔区域肿瘤复发及淋巴结转移,术后第二年有11例纵隔区域肿瘤复发及淋巴结转移;对照组术后第一年有14例出现纵隔区域肿瘤复发及淋巴结转移,术后第二年23例出现纵隔区域肿瘤复发及淋巴结转移。结论:晚期食管癌术中纵隔热灌注化疗可明显减少或延迟纵隔区域肿瘤复发及淋巴转移,提高术后第一至第二年生存率。Abstract: Objective: To explore the advanced esophageal cancer resection, mediastinum, lymph node dissection, mediastinum, hot infusion chemoembolization and clinical observation of residual heat infusion chemoembolization and trachea, or the thoracic aorta, bronchus, eye cancer organs such as intravenous of tiny lesions therapeutic effect. Methods: Select esophageal lesions than the outer membrane layer of infiltrating the trachea and bronchus to the thoracic aorta, and 112 cases of patients with venous organs such as random points to two groups: treatment group treated with perfusion of 56 cases at 4243 degrees Celsius sterile 2000 mL distilled water 2500 mL ~ (DDP) joined cisplatin 150 mg, 5fluorouracil (5FU 1200 mg) in extracorporeal circulation downlink mediastinal hot perfusion 40 minutes, control group treated with perfusion of 56 cases without mediastinal hot perfusion chemotherapy. Results: Treatment group in 6 cases occured after first mediastinal tumor recurrence and regional lymph node metastases after 11 cases, the regional recurrence and lymphatic metastasis mediastinal, control group first fill after 14 cases mediastinal tumor recurrence and bureau of regional lymph node metastasis appeared in 23 cases, surgery between regional tumor locally recurrent lymph node metastases. Conclusion: Advanced esophageal intraoperative mediastinal hot perfusion chemotherapy can obviously reduce or delay mediastinal tumor recurrence and regional lymph node metastases, raise the firstsurial.
目的：探讨少见纵隔占位病变的螺旋CT表现特征及其病理基础，以提高临床认识及诊治水平。方法：回顾性分析经临床病理证实的原发性少见纵隔占位病变的螺旋CT表现，观察和评价肿块内部结构、密度分布、边缘特征、强化特征等CT表现特点及其优势解剖分布。结果：32例少见纵隔肿块中良性22例（68.75％，22/32），恶性10例（10/32，31.25％）。22例良性肿块中密度均匀12例（12/22，5454％），形态规则16例（16/22，72.72％），边界清楚14例（14/22，63.64％），低密度15例（15/22，68.18％）。10例恶性肿块中密度不均匀7例（7/10，70％），形态不规则8例（8/10，80％），边界不清楚6例（6/10，60％），中等密度6例（6/10，60％）。32例肿块中位于上纵隔12例，前纵隔16例，中纵隔9例，后纵隔11例。良性肿块常累及一个解剖分区（15/22,68.18％），恶性多累及二个区以上（6/10,60％）。结论：不同的少见纵隔肿块具有不同特征CT表现及其好发部位，这与其解剖来源和其组织成分不同有关
Objective To describe a case of giant asymptomatic neurilemmoma of mediastinum. Methods The clinical, radiographic and pathological characteristics of a patient admitted to Changhai Hospital Affiliated to Second MilitaryMedical University in May 2009 presenting with large shadow on chest radiograph was analyzed, and related literature was reviewed. Results Radiographic examination revealed a large mass occupying the right thoracic cavity. Then the pathological issue was obtained bypercutaneous CT-guided needle biopsy. Neurilemmoma was proved by pathological study. Conclusions The low morbidity of giant neurilemmoma of mediastinum, with most of the cases remaining asymptomatic, is prone to misdiagnosis. The large mediastinal mass in the thoracic cavity increases the risk of thoracotomy. It can bepathologically diagnosed through percutaneous image-guided needle biopsy or surgical biopsy.
Abstract： Objective To investigate the indications， surgical techniques and postoperative complication management of transhiatal esophagectomy without thoracotomy for patients with esophageal cancer. Methods We retrospectively analyzed the clinical records of 105 patients with esophageal cancer who underwent transhiatal esophagectomy without thoracotomy in the First Affiliated Hospital of Nanjing Medical University between July 2002 and July 2010， including 28 patients who received video-assisted mediastinoscopy. There were 59 male patients and 46 female patients with their average age of 63 （48-81） years. There were 51 patients with upper thoracic esophageal cancer， 18 patients with middle thoracic esophageal cancer and 36 patients with lower thoracic esophageal cancer. Surgical outcomes and safety were evaluated. Results Mean operation time was 153 （140-210） minutes， mean intraoperative blood loss was 150 （100 to 250） ml， and mean hospital stay was 15 （10-35） days. There was no in-hospital death or residual tumor cells in esophagus stumps. Twenty-seven patients had postoperative complications， including 3 patients with anastomotic leakage at neck， 4 patients with recurrent laryngeal nerve injury， 5 patients with pleural effusion， 2 patients with pneumothorax， 3 patients with pneumonia， 3 patients with arrhythmia， 1 patient with chylothorax， 2 patients with incision infection， 2 patients with delayed gastric emptying， and 2 patients with anastomotic stenosis， who were all cured after treatment. Ninety-seven patients were followed up from 16 months to 5 years， and 8 patients were lost during follow-up. During follow-up， there were 94 patients who had lived for 1 year， 67 patients who had lived for 3 years， and 34 patients who had lived for 5 years postoperatively， and some patients needed further follow-up. Conclusion Transhiatal esophagectomy without thoracotomy is a minimally traumatic procedure and can provide fast postoperative recovery. It is especially suitable for patients with stageⅡor earlier esophageal cancer who can’t tolerate or aren’t suitable for transthoracic esophagectomy.