CAJ | 학술논문

目的探讨经改良的颈胸前入路治疗肺上沟瘤的临床经验.方法回顾性分析2005年7月至2010年5月收治的3例肺上沟瘤患者的临床资料,3例患者均经改良的颈胸前入路切口,将第1～3肋骨全部切除,切除1/5椎体1例,第1胸椎横突切除1例,第1、2胸椎横突切除1例,胸1神经根及星状神经节切除1例.结果 3例患者术后均恢复顺利,除1例患者术后出现继发性Horner综合征外,无严重并发症发生.3例患者于术后换药时,均见有轻度反常呼吸,但无呼吸困难,耐受良好,继续胸壁加压包扎14d后等待纵隔固定,反常呼吸消失.术后病理诊断:鳞癌2例,腺鳞癌1例,均未见纵隔淋巴结转移,肿瘤切缘阴性.分期:T3NoM02例,T4N0M01例.3例患者术后均行4个周期化疗(NP方案),未行放疗.3例患者术后分别随访53、37、13个月,均存活,肿瘤无局部复发,患者生活质量良好.结论经改良的颈胸前人路能完整切除肺上沟瘤,对侵及胸廓入口处的结构处理方便、安全,是值得推广的手术方法.
목적 탐토경개량적경흉전입로치료폐상구류적림상경험.방법 회고성분석2005년7월지2010년5월수치적3례폐상구류환자적림상자료,3례환자균경개량적경흉전입로절구,장제1～3륵골전부절제,절제1/5추체1례,제1흉추횡돌절제1례,제1、2흉추횡돌절제1례,흉1신경근급성상신경절절제1례.결과 3례환자술후균회복순리,제1례환자술후출현계발성Horner종합정외,무엄중병발증발생.3례환자우술후환약시,균견유경도반상호흡,단무호흡곤난,내수량호,계속흉벽가압포찰14d후등대종격고정,반상호흡소실.술후병리진단:린암2례,선린암1례,균미견종격림파결전이,종류절연음성.분기:T3NoM02례,T4N0M01례.3례환자술후균행4개주기화료(NP방안),미행방료.3례환자술후분별수방53、37、13개월,균존활,종류무국부복발,환자생활질량량호.결론 경개량적경흉전인로능완정절제폐상구류,대침급흉곽입구처적결구처리방편、안전,시치득추엄적수술방법.
Objective To investigate the experience of resection of superior sulcus tumors using the improved antero-cervical parastemal approach.Methods The clinical data of 3 patients with superior sulcus tumor from July 2005 to May 2010 were analyzed retrospectively.Three patients with superior sulcus tumor underwent en bloc resection using the improved antero-cervical parastemal approach.The 1st to 3rd rib were excised,1 case with 1/5 centrum vertebra excision,1 case with the 1st transverse process of thoracic vertebra excision,1 case with the 1 st and 2nd transverse process of thoracic vertebra excision,1 case with T1 nerve root and sellate ganglion excision.Results All the patients recovered well after operation.There was no serious complication except for 1 case with secondary Horner syndrome.The mild paradoxicalbreathing was found in 3 cases postoperative dressing change,but they had no dyspnea and tolerance well.The paradoxical breathing was disappeared when the mediastinum was fixed after 14 d thoracic wall pressure dressing.The pathological diagnosis after operation:2 cases with squamous-celled carcinoma,1 case with adenosquamous carcinoma,there was no mediastinal lymph node metastasis,cutting edge was negative.Stage:2 cases with T3N0M0,1 case with T4N0M0.Three cases were treated with chemotherapy (NP plan) for 4 cycles after operation without radiotherapy.Three cases were followed up for 53,37, 13 months after operation,they were all survival without recurrence and good quality life.Conclusions For the treatment of especially anterior and middle seated superior sulcus tumors,improved antero-cervical parasternal approach provides a safe and effective exposure.The improved antero-cervical parasternal approach is worthy of promotion.