Safe diagnostic management of malignant mediastinal tumors in the presence of respiratory distress: a 10-year experience
Safe diagnostic management of malignant mediastinal tumors in the presence of respiratory distress: a 10-year experience
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DOI：
10.1186/s12887-020-02183-w
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发表时间：
2020-06-10
期刊：
影响因子：
2.4
通讯作者：
Uchida, Hiroo
中科院分区：
文献类型：
--
作者：
Tanaka, Tomoko;Amano, Hizuru;Uchida, Hiroo
背景儿童恶性纵隔肿瘤的基本治疗方法是化疗。因此，准确的诊断对选择合适的化疗方案至关重要。然而，恶性纵隔肿瘤有时会引起呼吸窘迫，而全身麻醉下的活检对这类患者来说是危险的，因为有创机械通气会加剧质量效应引起的呼吸道阻塞。在这项研究中，我们回顾了我们10年的诊断经验，以评估我们做法的有效性，并为未来的患者确定安全的诊断方案。方法回顾分析2007~2018年在名古屋大学医院就诊的表现为呼吸窘迫的纵隔恶性肿瘤患儿的临床资料。呼吸窘迫包括呼吸困难、大量胸腔积液、喘息和肿瘤引起的低氧血症。收集性别、发病年龄、首发症状、肿瘤部位、治疗策略(尤其是诊断和确诊方法)、临床病程、急性期(自出现呼吸道症状起3个月内)及远期预后等资料。结果12例儿科患者符合复习标准。前纵隔肿瘤7例，后纵隔肿瘤5例。所有前纵隔肿瘤均通过骨髓涂片、胸腔穿刺术或核心针活检确诊，同时保持自主呼吸。对于后部肿瘤，2例患者通过核心针活检和自主呼吸下的淋巴清扫活检确诊。两例患者最初仅使用肿瘤标志物进行诊断。1例重度气管压迫行肿瘤切除，备用体外膜肺氧合。没有患者死于诊断程序相关的并发症。结论在所回顾的12例中，有11例在没有全身麻醉的情况下安全、准确地诊断了肿瘤。没有全身麻醉的诊断策略考虑到肿瘤的位置被证明是有用的。
Background The fundamental treatment for patients with pediatric malignant mediastinal tumors is chemotherapy. Therefore, accurate diagnosis is essential for selecting the appropriate chemotherapeutic regimen. However, malignant mediastinal tumors occasionally cause respiratory distress, and biopsies under general anesthesia are dangerous for such patients as invasive mechanical ventilation can aggravate airway obstruction caused by mass effect. In this study, we reviewed our 10-year diagnostic experience to evaluate the efficacy of our practices and confirm a safe diagnostic protocol for future patients. Methods We retrospectively reviewed medical records of children with malignant mediastinal tumors diagnosed at Nagoya University Hospital from 2007 to 2018 who demonstrated respiratory distress. Respiratory distress included dyspnea, massive pleural effusion, wheezing, and hypoxemia owing to tumors. Data on sex, age at onset, primary symptoms, location of tumor, management strategy (especially the method of diagnosis and definitive diagnosis), clinical course, prognosis during the acute phase (within 3 months from the onset of respiratory symptoms), and long-term outcome were collected. Results Twelve pediatric patients met the review criteria. There were seven anterior mediastinal tumors and five posterior mediastinal tumors. All anterior mediastinal tumors were diagnosed via bone marrow smear, thoracentesis, or core needle biopsy while maintaining spontaneous breathing. Regarding posterior tumors, two patients were diagnosed via a core needle biopsy and lymph node excisional biopsy under spontaneous breathing. Two cases were initially diagnosed solely using tumor markers. One patient with severe tracheal compression underwent tumor resection with extracorporeal membrane oxygenation stand-by. No patient died of diagnostic procedure-related complications. Conclusions In 11 of the 12 cases reviewed, safe and accurate tumor diagnosis was accomplished without general anesthesia. A diagnostic strategy without general anesthesia considering the tumor location proved to be useful.