ObjectiveTo report the effect and experience of the extended resection and reconstruction of superior vena cava(SVC) and innominate vein for invasive mediastinal tumors.MethodsA retrospective study of 11 patients who underwent extended resection and grafts of SVC and innominate vein for invasive mediastinal tumor in Peking Union Medical College Hospital from 2001 to 2003 was performed. Radical resection was performed in 9 cases, among which SVC and left innominate vein were reconstructed with pericardium patch in 2, with prostheses(ringed GoreTex) interposed in 7.The other 2 patients who had incomplete resection also underwent prostheses interposition for SVC reconstruction. During operation, SVC and left innominate vein were clamped in turn,to avoid total interruption of blood return, clamping time for each site was 22.15±6.29 min. The volume of blood loss was 1 342.86± 692.48ml during operation.ResultsThe tumor included 4 invasive thymoma, 5 thymic cancer, 2 primary mediastinal small cell carcinoma. The patency was good in the grafts with external ring support and no SVC symptoms were observed in all cases postoperatively. One patient died of respiratory infection two weeks after operation, others are alive till now. The longest patent and functional graft is 30 months postoperatively.ConclusionSVC and innominate vein reconstruction by prostheses interposition can effectively eradicate the SVC syndrome. Clamping SVC needs careful study. Attention to the invasive extention of tumor should be made to avoid palliative operation,because complete resection is most important for long term survival.
Objective To investigate the clinicopathological characteristics and surgical treatment of intrathoracic Castleman disease(CD). Methods Clinical data of 14 cases pathologically diagnosed as CD as analysed retrospectively. There were 6 males and 8 females, with an average age of 29 years(17-58). All were undergone surgical resection or biopsy. Among the 12 patients who had unicentric CD, 11 were performed open thoracotomy and lymphadenectomy with posterolateral or sternum approach, and one was treated by video assisted mini thoracotomy(VAMT). For the diagnosis of multicentric CD, one of the 2 patients had video assisted thoracic surgery(VATS) and wedge resection of the lung, and the other had video mediastinoscopy. Results No patient died perioperatively. All were successfully restored except two complications. One had dyspnea in the second postoperative day, as a result of the softening and collapse of bronchial wall in the entrance of the right main bronchus, which revealed by bedside fiberoptic bronchoscopy. One who had lymphadenopathy in the aortopulmonary window suffered from transient hoarseness after surgery. They recovered after symptomatic treatment finally. Regarding pathological classification, there were 11 cases of hyaline vascular type, 2 cases of plasma cell type and 1 case of mixed cellularity type. 13 cases were followed up for 8-110 months and longterm survive was achieved. No recurrence was observed in the 11 cases with unicentric CD and no relapse was occurred in the 2 cases with multicentric CD. Conclusion Both freezing pathology during operation and paraffin pathology postoperation are important for establishing the diagnosis. For unicentric CD, the clinical symptoms are significantly alleviated and it can be universally cured after operation. Multicentric CD needs multiple therapies after the diagnostic procedure and close follow-up.
目的 分析輪狀病毒性腹瀉患兒心肌受損情況和所伴隨生化檢驗指標改變。 方法 2008年7月－2010年7月收治腹瀉患兒80例，年齡6～27個月，平均12.9個月。其中有50例為輪狀病毒腹瀉（A組），30例為非輪狀病毒性腹瀉（B組）。A組患兒均符合輪狀病毒腹瀉診斷標準，有心肌損傷的異常指標但達不到心肌炎診斷標準者診斷為心肌損害。B組患兒有水樣腹瀉，但癥狀較輕，病程較短，輪狀病毒抗原檢測陰性。用全自動生化分析儀測定血清谷草轉氨酶、乳酸脫氫酶、肌酸磷酸激酶和肌酸磷酸激酶同工酶，免疫親和層析法測定血清肌鈣蛋白值，并進行心電圖檢查。 結果 A組50例輪狀病毒性腹瀉患兒中，44例（88.0%）存在心肌損害，其血清谷草轉氨酶（74.32 ± 13.77）U/L、肌酸磷酸激酶（52.01 ± 10.37）U/L、肌酸磷酸激酶同工酶（273.43 ± 27.55）U/L均升高，且明顯高于B組[（24.98 ± 7.03）、（17.11 ± 6.52）、（151.46 ± 16.52）U/L]，差異有統計學意義(P＜0.05)。兩組患兒的乳酸脫氫酶變化差異無統計學意義(P＞0.05)。 結論 輪狀病毒性腹瀉患兒往往伴有心肌損害及相應的血液生化檢測指標改變；以肌酸磷酸激酶同工酶作為近期心肌損害的診斷指標更為特異和敏感。
Objective To investigate the clinicopathological characteristics and surgical treatment of intrathoracic Castleman disease(CD). Methods Clinical data of 14 cases athologically diagnosed as CD as analysed retrospectively. There were 6 males and 8 females, with an average age of 29 years(17-58). All were undergone surgical resection or biopsy. Among the 12 patients who had unicentric CD, 11 were performed open thoracotomy and lymphadenectomy with posterolateral or sternum approach, and one was treated by video assisted mini thoracotomy(VAMT). For the diagnosis of multicentric CD, one of the 2 patients had video assisted thoracic surgery(VATS) and wedge resection of the lung, and the other had video mediastinoscopy. Results No patient died perioperatively. All were successfully restored except two complications. One had dyspnea in the second postoperative day, as a result of the softening and collapse of bronchial wall in the entrance of the right main bronchus, which revealed by bedside fiberoptic bronchoscopy.One who had lymphadenopathy in the aortopulmonary window suffered from transient hoarseness after surgery. They recovered after symptomatic treatment finally. Regarding pathological classification, there were 11 cases of hyaline vascular type, 2 cases of plasma cell type and 1 case of mixed cellularity type. 13 cases were followed up for 8-110 months and longterm survive was achieved. No recurrence was observed in the 11 cases with unicentric CD and no relapse was occurred in the 2 cases with multicentric CD. Conclusion Both freezing pathology during operation and paraffin pathology postoperation are important for establishing the diagnosis. For unicentric CD, the clinical symptoms are significantly alleviated and it can be universally cured after operation. Multicentric CD needs multiple therapies after the diagnostic procedure and close follow-up.
Abstract: Objective To investigate the clinical features of solitary fibrous tumor (SFT) in the thorax and its optimal surgical approaches. Methods We retrospectively reviewed the clinical records of 16 patients with SFT in the thorax in our hospital between January 2004 and June 2010. There were 8 males and 8 females, with a median age of 49 years (1973 years). Laboratory examination showed normal results. Chest Xray and computed tomographic scan revealed lung tumor in 8 cases, mediastinal mass in 3 cases, fibrous tumor in 2 cases, pleural mass in 2 cases, and retroperitoneal mass in 1 case. Five patients underwent CT guided biopsy or thoracoscopy, and 3 of them were diagnosed to have SFT. There was no clear diagnosis for the remaining 13 cases before operation. None of them had been exposed to asbestos. Symptoms were present in 5 patients. All patients underwent surgical treatment with resection performed through routine thoracotomy in 10 cases and by means of videoassisted thoracoscopy in 6 cases. The tumors originated from the visceral pleura in 12 patients, from parietal pleura in 3 patients (from diaphragmatic pleura in 1, and costal pleura in 2), and from the lung in 1 patient. Results All tumors were totally excised. Immunohistochemical staining showed CD34 was positive in all tumors. There was no postoperative mortality and no major complications. All patients were regularly rechecked and followed up. The followup was ranged from 1 to 72 months, with a median time of 21 months. During the followup, all patients survived and no recurrence was observed by means of chest X radiography or CT. Conclusion SFT tumors in the thorax are rare neoplasms and can have giant diameters. Wide local excision is recommended as the best therapeutic option. The SFT has the possibility of recurrence, and careful longterm clinical followup is required.