A multidisciplinary approach to the management of anterior mediastinal masses in children
A multidisciplinary approach to the management of anterior mediastinal masses in children
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DOI：
10.1016/j.jpedsurg.2014.09.054
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发表时间：
2015-05-01
影响因子：
2.4
通讯作者：
Partrick, David A.
中科院分区：
文献类型：
--
作者：
Acker, Shannon N.;Linton, Jacqueline;Partrick, David A.
目的：前纵隔肿块(AMM)对外科医生、肿瘤学家、麻醉科医生、重症医生和介入放射科医生提出了诊断上的挑战，因为全身麻醉诱导会导致呼吸道阻塞和心血管衰竭。方法：我们对2002年至2012年间实体肿瘤门诊确诊的所有AMM患者进行了回顾性分析，包括术前评估和处理、临床病程和并发症。结果：69例AMM患者(平均年龄12.2±4.4岁，%，男性)继发于霍奇金淋巴瘤(34例)、非霍奇金淋巴瘤(26例)和其他诊断(9例)。大多数患者(56，81.2%)接受了纵隔肿块外组织的活检。局麻加镇静治疗21例(30%)活检成功。4例(5.8%)因初次活检标本不充分而需要重复活检。3例(4.4%)出现呼吸道并发症，无死亡或严重并发症。结论：我们的数据表明，在大多数AMM儿童中，从肿块外的组织获得组织活检是成功的，并发症最少，强调了多学科术前计划的重要性，以将麻醉风险降至最低。(C)2015 Elsevier Inc.保留所有权利。
Purpose: Anterior mediastinal masses (AMM) pose a diagnostic challenge to surgeons, oncologists, anesthesiologists, intensivists, and interventional radiologists as induction of general anesthesia can cause airway obstruction and cardiovascular collapse. We hypothesized that in the majority of patients, diagnosis can be obtained through biopsy of extrathoracic tissue.Methods: We performed a retrospective review of all patients in the solid tumor oncology clinic with a diagnosis of AMM between 2002 and 2012 including preoperative evaluation and management prior to obtaining a tissue diagnosis, clinical course and complications.Results: We identified 69 patients with AMM(mean age 12.2 +/- 4.4 years, 64% male) secondary to Hodgkin lymphoma (34), Non-Hodgkin lymphoma (26), and other diagnoses (9). The majority of patients (56, 81.2%) underwent biopsy of tissue outside of the mediastinal mass. Local anesthesia with sedation was used for successful biopsy in 21 (30%) patients. Four (5.8%) required repeat biopsy due to inadequate sample obtained at initial procedure. Three (4.4%) suffered respiratory complications with no fatalities or severe complications.Conclusions: Our data demonstrate that in the majority of children with AMM, tissue biopsy can be successfully obtained from tissue outside of the mass itself with minimal complications and highlight the importance of multidisciplinary preoperative planning to minimize anesthetic risks. (C) 2015 Elsevier Inc. All rights reserved.