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目的探讨颈部、胸腔和腋窝交汇处良性肿瘤的手术方法及其疗效。方法回顾分析1999年10月至2006年3月期间11例发生于颈部、胸腔和腋窝交汇区域良性肿瘤患者的诊治过程,其中神经鞘膜瘤5例,神经纤维瘤3例,软骨瘤2例,脊膜瘤1例。CT 检查示所有患者的肿瘤均不同程度侵犯颈部、胸腔和腋窝,其中4例患者伴椎体破坏,1例伴脊髓压迫。离断胸骨柄,保留胸锁关节完整,将锁骨移位后分别分离解剖颈部、腋窝及上纵隔血管,直视下切除肿瘤。其中1例行锁骨下静脉重建。结果术中椎动脉起始部裂隙状损伤2例,在阻断锁骨下动脉及椎动脉远心端后成功缝合。所有患者术后上肢功能均恢复良好,无永久性颅神经麻痹,无乳糜瘘或术后感染。随诊3个月至3年5个月,CT 检查未见肿瘤残存或复发。结论采用锁骨移位方法可在直视下彻底切除颈部、胸腔和腋窝交汇区域良性肿瘤,并较好地保护该区域重要血管神经。
Objective To investigate the surgical methods and the curative effects of benign tumors at the junction of the neck, chest and armpit. Methods From October 1999 to March 2006, 11 cases of benign tumors in the junction of the neck, chest and armpit were diagnosed and treated. Among them, 5 were neurofibroma, 3 were neurofibroma, 2 were chondroma , Meningiomas in 1 case. CT examination showed that all patients had different degrees of tumor invading the neck, chest and armpits. Among them, 4 patients had vertebral body destruction and 1 patient had spinal cord compression. Broken sternum handle, leaving the sternoclavicular joint intact, respectively, after the separation of the clavicle anatomical neck dissection, armpits and upper mediastinal vessels, resection of the tumor under direct vision. One case underwent subclavian vein reconstruction. Results 2 cases of vertebral artery at the beginning of the fracture-like injury, blocking the subclavian artery and the distal end of the vertebral artery after successful suture. All patients recovered well after surgery, no permanent cranial nerve paralysis, no chylothorax or postoperative infection. Follow-up 3 months to 3 years and 5 months, no residual tumor or recurrence of CT examination. Conclusion The clavicle transposition method can completely remove benign tumors in the intersection of the neck, chest cavity and armpit under direct vision and protect the important vascular nerves in this area.