Thedosios DOSIOS, Efstratios KOUSKOS, Vasiliki KYRIAKOU

Surgical management of mediastinal lesions

Mediastinal tümörler ve kistler histolojik tanı gerektiren oldukça nadir lezyonlardır. Bu retrospektif çalışma, mediastinal lezyonların tanı ve tedavisinde kliniğimizin deneyimini aktarmaktadır. Yirmisekiz yıl süresince cerrahi olarak tedavi edilen, yaşları 6-84 arasında değişen 200 hastadaki mediastinal lezyonlar bu çalışmaya dahil edildi. Altmış hastada ön üst mediastinde belirgin olarak rezeke edilemeyen lezyon veya lenfadenopati vardı. Bu hastalara anterior mediastinotomi ve mediastinal kitleden biyopsi yapıldı. Bu hastalarda peroperatif ölüm saptanmadı. Beş (%8.3) hastada komplikasyon gözlendi. Tüm hastalarda histolojik tanı konuldu: Lenfoma (n= 21), metastatik karsinoma (n= 16), timik lezyonlar (n= 10), germ hücreli tümör (n= 3), diğer lezyonlar (n= 10). Geri kalan 140 hastada kitle rezeke edildi. Bir (%0.7) hastada peroperatif ölüm ve 21 (%15) komplikasyon gözlendi. Çıkartılan kitlelerin histolojik tanısı: Timik lezyonlar (n= 60), nöral tümörler (n= 21), tiroid lezyonları (n= 14), bronşiyal kistler (n= 12), perikardiyal kistler (n= 10), germ hücreli tümörler (n= 6), diğer lezyonlar (n= 17) idi. Sonuçlarımız uluslararası literatür ile uyumludur. Mediastinal lezyonlu hastalarda cerrahi, tercih edilen tadavidir. Cerrahi işlem, gerektiğinde düşük ameliyat riski ile lezyonun kesin tanı ve küratif eksizyonuna olanak sağlamaktadır.

Mediastinal lezyonların cerrahi tedavisi

Mediastinal tumors and cysts are relatively uncommon lesions requiring histologic confirmation. This retrospective study reports the experience of our department in the diagnosis and treatment of mediastinal lesions. Mediastinal lesions that were surgically treated in 200 patients aged 6-84 years, during a period of 28 years, were included in this series. Sixty patients had an apparently non-resectable lesion or lymphadenopathy of the anterior superior mediastinum. They had an anterior mediastinotomy and biopsy of the mediastinal lesion. No perioperative deaths were recorded in those patients. There were recorded 5 (8.3%) complications. Histological diagnosis was established in all patients: lymphoma (n= 21), metastatic carcinoma (n= 16), thymic lesions (n= 10), germ cell tumor (n= 3), other lesions (n= 10). The remainder 140 patients underwent a resection of the mediastinal lesion. One (0.7%) perioperative death and 21 (15%) complications were recorded. The histological diagnosis of the excised lesions was: thymic lesions (n= 60), neural tumors (n= 21), thyroid lesions (n= 14), bronchial cysts (n= 12), pericardial cysts (n= 10), germ cell tumors (n= 6), other lesions (n= 17). Our results are compared favorably with those reported in international literature. Surgery is the management of choice for patients with mediastinal lesions. It allows for establishing certain histological diagnosis and curative excision of the lesion, when it is necessary, with low operative risk.

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