縦隔神経原性腫瘍切除例の検討 CLINICOPATHOLOGICAL STUDY ON SURGICALLY TREATED CASES OF NEUROGENIC MEDIASTINAL TUMORS

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1969年から1997年に当科で切除した神経芽細胞腫を除く縦隔神経原性腫瘍62例(男性39例,女性23例,平均年齢35.9歳)を対象として検討を行った.腫瘍の局在は縦隔の右側37例,左側25例で, Th 4より頭側に存在する症例が多く,経時的な観察により36.8%で胸部X線写真上,腫瘤の増大を認め,有症状例での腫瘤は大きい傾向であった.発生神経は交感神経32例,肋間神経21例,迷走神経5例,横隔神経1例などであり,完全切除の方針で手術を施行した.しかし, 5例は全摘できなかったものの再発しておらず,また,悪性例も認められなかった.一方, Horner症候群などの術後合併症は23例に認めた.以上より本症は完全摘出が最も望ましいものの,特に機能障害が問題となる反回神経,横隔神経,および上部交感神経では神経機能の温存を考慮するべきであり,手術は低侵襲性の点から胸腔鏡下切除を第一に選択すべきと考える.

Sixty-two patients with neurogenic mediastinal tumor surgically treated in our department from 1969 to 1997 except for neuroblastoma were clinicopathylogically reviewed. Tumors existed on the right side of the mediastinum in 37 patients, on the left in 25 patients, and were located above the Th 4 frequently. Chest roentgenograms showed development of tumors in 36.8% of cases who had observation periods before surgery. There were no malignant tumors and tumors grew from sympathetic nerves in 32 patients, intercostal nerves in 21, vagus nerves in five, and phrenic nerve in one. An operation was carried out to resect tumors completely for every patient, in five patients, however, complete resection was not possible because tumors extended into cervical motor nerves. As a result of surgery, 23 patients suffered from postoperative complication (Horner syndrome in 15 patients, bleeding in 3. hoarseness in 2, and pain in 2), and there were no recurrence even in the five patients for whom complete resection was impossible.<br> Therefore, we would conclude that neurogenic mediastinal tumors should be resected surgically with keeping up nervous function. Taking its less stress into consideration, thoracoscopic resection must be the management of first choice.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 60(11), 2831-2835, 1999-11-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10008498069
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    13452843
  • データ提供元
    CJP書誌  J-STAGE 
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