摘要目的 探讨改良半蛤壳切口(modified hemi-clamshell approach)应用于前纵隔巨大肿瘤治疗中的安全性、有效性、适应证及其特点.方法 2003年4月至2012年5月,应用改良式半蛤壳切口治疗前纵隔巨大肿瘤24例,男18例,女6例;中位年龄40岁;肿瘤平均11.3 cm ×9.3 cm.术中作患侧第3或4肋间锁骨中线至对侧胸骨旁线横断胸骨切口,行前纵隔肿瘤的根治或姑息性手术切除.术毕细钢丝单纯缝合固定胸骨.结果 全组无围手术期与手术相关的死亡;仅1例胸腺瘤合并重症肌无力患者术后出现一过性肌无力危象,余者无严重并发症发生.24例中肿瘤根治性切除15例,平均肿瘤11.2cm×9.1cm;姑息性切除9例,平均肿瘤11.3 cm×9.5 cm.术中因肿瘤周围组织受累而行扩大手术切除者14例,包括肺楔形切除8例次、肺叶切除1例次、全肺切除1例次,膈神经节段切除3例次,上腔静脉置换1例次,无名静脉侧壁切除5例次、无名静脉置换1例次,心包局部切除6例次.所有患者随访至2013年8月,随访6～124个月.良性患者术后生存11 ～124个月;恶性患者术后生存6～ 65个月.结论 改良半蛤壳切口制作简便、快捷,显露前纵隔结构良好,并发症少,用于前纵隔巨大肿瘤的治疗安全、有效,适合在基层推广,应用前景较好.

abstractsObjective To assess the safety,effectiveness,indications and advantage of modified "Hemi-Clamshell" approach for giant anterior mediastinal tumor.Methods From Apr 2003 to May 2012,24 patients (18 males and 6 females,median aged 40 years old) with giant anterior mediastinal tumor (average dimension:11.3 cm × 9.3 cm) were treated through modified "Hemi-Clamshell" approach.In operation,anterolateral thoracotomy with sternum transection was performed through 3rd or 4th intercostal space from midclavicular line to contralateral parasternal line.Then a radical or palliative resection of the tumor was performed.Results There were no mortality and major morbidity peri-operatively.A myasthenic crisis occurred for a patient with thymoma and myasthenia gravis.16 operations were performed through 3rd intercostal space and 8 through 4th.15 cases of tumor were radically resectedaverage dimension of tumors was 11.2 cm × 9.1 cm while the other 9 were palliativly resectedthe average dimension of tumors was 11.3 cm × 9.5 cm.Because of the extranodal invasion of the tumor,14 patients received extended operations.All the patients were followed-up to Aug 2013,the overall period of follow-up were 6-124 months.The survival postoperative for the patients of radical resection group were 11-124 months and for the palliative resection group were 6-66 months.Conclusion Manufacture of the modified "Hemi-Clamshell" approach is fast and convenient,and the exploration of the mediastinal organs is satisfied.This modified approach can be used for great majority of the mediastinal tumors.This approach is suitable for promotion at the primary hospitals and the prospect of application is well.