目的 探讨改进微创技术治疗大龄鸡胸患者的可行性及近期结果。 方法 回顾性分析自2009年7月至2011年7月北京军区总医院采用改进微创技术治疗16例大龄鸡胸患者的临床资料,男12例,女4例;年龄(19.8±4.7)岁。鸡胸指数(HI) 2.00±0.23。前胸壁凸起型10例,鸡胸漏斗胸混合型6例。患者仰卧位,在全身麻醉下施行手术。(1)胸骨沉降法:适宜前胸壁凸起型。取胸壁最凸点水平两侧腋中线做小切口,创出横行于前胸壁的胸肌下隧道,将已制备好的矫形板穿过肌下隧道,施压整形后矫形板两端用钢缆与肋骨固定; (2)胸骨抬举及沉降联合法:适宜混合型。用Nuss方法将矫形板置于胸骨最凹陷部位抬举;胸骨角处小切口胸骨截骨和畸形肋软骨切除成形沉降胸骨。 结果 无围术期死亡,16例均顺利完成手术,手术时间(65.0±7.8) min,失血量(20.0±4.2) ml,住院时间(5.0±1.8) d。术后胸廓外形恢复正常,HI 2.8±0.4。胸廓外形和胸部CT影像形状满意。随访 16例,随访时间12~30个月,平均随访18个月。其中1例已取出矫形板。疗效优秀13例(81.2%),良好3例(18.8%)。 结论 采用改进微创技术矫治大龄鸡胸患者,需要选择恰当的手术术式,可获得良好的近期效果。
Citation:
刘吉福,徐波,刘克强,谭健,裴迎新. 改进微创技术治疗大龄鸡胸患者的近期疗效. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(2): 235-237. doi: 10.7507/1007-4848.20130068
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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Castleman B, Iverson L, Menendez VP. Localized mediastinal lymphnode hyperplasia resembling thymoma. Cancer, 1956, 9 (4):822-830.
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Frizzra G. Castleman’s disease and related disorders. Semin Diagno Pathol, 1988, 5 (4):346-351.
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Shahidi H, Myers JL, Kvale PA. Castleman’s disease. Mayo Clin Proc, 1995, 70 (10):969-977.
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4. |
Seo HY, Kim EB, Kim JW, et al. Complete remission in a patient with human herpes virus-8 negative multicentric Castleman disease using CHOP chemotherapy. Cancer Res Treat, 2009, 41 (2):104-107.
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5. |
Sato N, Kondo S, Saito K, et al. Hyaline vascular-type Castleman’s disease in the hepatoduodenal ligament:report of a case. Surg Today,2006, 36 (7):647-650.
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6. |
Luppi M, Barozzi P, Maiorana A, et al. Human herpevirus-8 DNA sequences in human immunodeficiency virus-negative angioimmunoblastic lymphadenopathy and benign lymphadenopathy with giant germinal center hyperplasia and increased vascularity. Blood, 1996, 87 (9):3903.
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Casper C. The aetiology and management of Castleman disease at 50 years:translating pathophysiology to patient care. Br J Haematol, 2005, 129 (1):3-17.
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8. |
Bowne WB, Lewis JJ, Filippa DA, et al. The management of unicentric and multicentric Castleman’s disease:a report of 16 cases and a review of the literature. Cancer, 1999, 85 (3):706-717.
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9. |
Chronowski GM, Ha CS, Wilder RB, et al. Treatment of unicentric and multicentric Castleman disease and the role of radiotherapy. Cancer, 2001, 92 (3):670-676.
|
10. |
Herrada J, Cabanillas F, Rice L, et al. The clinical behavior of localized and multicentric Castleman disease. Ann Intern Med, 1998, 128 (8):657-662.
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11. |
Ruco LP, Gearing AJ, Pigott R, et al. Expression of ICAM-1, VCAM-1 and ELAM-1 in angiofollicular lymph node hyperplasia (Castleman’s disease):evidence for dysplasia of follicular dendritic reticulum cells. Histopathology, 1991, 19 (6):523-528.
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12. |
周乃康, 王波, 梁朝阳, 等. 胸内Castleman病的外科治疗. 解放军医学杂志, 2006, 31 (2):159-161.
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13. |
Ko SF, Hsieh MJ, Ng SH, et al. Imaging spectrum of Castleman’s disease. Am J Roentgenol, 2004, 182 (3):769-775.
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14. |
Harada N, Sayama K, Tanaka K, et al. Long-term treatment with a humanized anti-interleukin-6 receptor antibody (tocilizumab),improving interstitial pneumonia in a patient with multicentric Castleman disease. Nihon Kokyuki Gakkai Zasshi, 2010, 48 (2):145-150.
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15. |
Akashi A, Hazama K, Miyoshi S, et al. An analysis of video-assisted thoracoscopic resection for mediastinal masses in 150 cases. An overview of the pansternal approach, histology, and complications. Surg Endosc, 2001, 15 (10):1167-1170.
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16. |
Roviaro G, Varoli F, Nucca O, et al. Videothoracoscopic approach to primary mediastinal pathology. Chest, 2000, 117 (4):1179-1183.
|
17. |
李启英, 项颖. 多中心型 (浆细胞型)巨大淋巴结增生症1例及文献复习. 重庆医学, 2009, 38 (10):1271-1272.
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- 1. Castleman B, Iverson L, Menendez VP. Localized mediastinal lymphnode hyperplasia resembling thymoma. Cancer, 1956, 9 (4):822-830.
- 2. Frizzra G. Castleman’s disease and related disorders. Semin Diagno Pathol, 1988, 5 (4):346-351.
- 3. Shahidi H, Myers JL, Kvale PA. Castleman’s disease. Mayo Clin Proc, 1995, 70 (10):969-977.
- 4. Seo HY, Kim EB, Kim JW, et al. Complete remission in a patient with human herpes virus-8 negative multicentric Castleman disease using CHOP chemotherapy. Cancer Res Treat, 2009, 41 (2):104-107.
- 5. Sato N, Kondo S, Saito K, et al. Hyaline vascular-type Castleman’s disease in the hepatoduodenal ligament:report of a case. Surg Today,2006, 36 (7):647-650.
- 6. Luppi M, Barozzi P, Maiorana A, et al. Human herpevirus-8 DNA sequences in human immunodeficiency virus-negative angioimmunoblastic lymphadenopathy and benign lymphadenopathy with giant germinal center hyperplasia and increased vascularity. Blood, 1996, 87 (9):3903.
- 7. Casper C. The aetiology and management of Castleman disease at 50 years:translating pathophysiology to patient care. Br J Haematol, 2005, 129 (1):3-17.
- 8. Bowne WB, Lewis JJ, Filippa DA, et al. The management of unicentric and multicentric Castleman’s disease:a report of 16 cases and a review of the literature. Cancer, 1999, 85 (3):706-717.
- 9. Chronowski GM, Ha CS, Wilder RB, et al. Treatment of unicentric and multicentric Castleman disease and the role of radiotherapy. Cancer, 2001, 92 (3):670-676.
- 10. Herrada J, Cabanillas F, Rice L, et al. The clinical behavior of localized and multicentric Castleman disease. Ann Intern Med, 1998, 128 (8):657-662.
- 11. Ruco LP, Gearing AJ, Pigott R, et al. Expression of ICAM-1, VCAM-1 and ELAM-1 in angiofollicular lymph node hyperplasia (Castleman’s disease):evidence for dysplasia of follicular dendritic reticulum cells. Histopathology, 1991, 19 (6):523-528.
- 12. 周乃康, 王波, 梁朝阳, 等. 胸内Castleman病的外科治疗. 解放军医学杂志, 2006, 31 (2):159-161.
- 13. Ko SF, Hsieh MJ, Ng SH, et al. Imaging spectrum of Castleman’s disease. Am J Roentgenol, 2004, 182 (3):769-775.
- 14. Harada N, Sayama K, Tanaka K, et al. Long-term treatment with a humanized anti-interleukin-6 receptor antibody (tocilizumab),improving interstitial pneumonia in a patient with multicentric Castleman disease. Nihon Kokyuki Gakkai Zasshi, 2010, 48 (2):145-150.
- 15. Akashi A, Hazama K, Miyoshi S, et al. An analysis of video-assisted thoracoscopic resection for mediastinal masses in 150 cases. An overview of the pansternal approach, histology, and complications. Surg Endosc, 2001, 15 (10):1167-1170.
- 16. Roviaro G, Varoli F, Nucca O, et al. Videothoracoscopic approach to primary mediastinal pathology. Chest, 2000, 117 (4):1179-1183.
- 17. 李启英, 项颖. 多中心型 (浆细胞型)巨大淋巴结增生症1例及文献复习. 重庆医学, 2009, 38 (10):1271-1272.