The treatment of thymoma

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The thymus is an important immune organ in human body, originated in the thymic epithelial cells or lymphocytes of thymus tumor is the most

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The thymus is an important immune organ in human body, originated in the thymic epithelial cells or lymphocytes of thymus tumor is the most common, accounting for 95% in the whole of thymic tumor, mediastinum tumors or 1 ~ 3.

[treatment]

(1) the principle of treatment of thymoma was diagnosed that surgical resection. The reason is that the tumor continues to grow, and the adjacent tissues and organs are compressed to produce obvious clinical symptoms. It is difficult to judge the benign and malignant tumor from the clinical and X-ray manifestations. Therefore, whether benign or malignant thymoma should be removed as soon as possible. There are resectable malignant thymoma desirable biopsy guide postoperative treatment, partial excision and radiotherapy can relieve symptoms of prolonged survival.

(2) thoracoscopic minimally invasive treatment: before thymectomy should split sternum, injury, postoperative scar left large, seriously affect the appearance, and easy to cause the damage of lung function, phrenic nerve injury, mediastinal and pulmonary infection and other complications, many patients can not accept. Now, the minimally invasive surgical removal of the thymus, which is represented by thoracoscopy, shows great superiority. The utility model has the advantages of small trauma, light pain, quick recovery, reliable curative effect, small incision, and the like, and can meet the requirements of patients for health and beauty. In particular, the modern video-assisted thoracoscopic surgery to expand the visual field, the screen display is easy to operate with physicians, while shortening the operation time. Recently, video-assisted thoracoscopic thymectomy and minimally invasive thymectomy for myasthenia gravis were performed in Shanghai Yuanda Cardiothoracic Hospital.

(3) should pay attention to the problem: the operation of benign thymoma isolated without adhesion, complete removal of difficulties, surgery can be successfully completed, but some complex cases to fully estimate the difficulties. Malignant thymoma must first exploration, make clear the relationship between tumor and surrounding organs and anatomy. Located in the heart of the upper mediastinal thymoma glue, heart and great vessels at the junction of malignant thymoma; infiltration to the surrounding adhesions; tumor growth when adjacent organs were passed, the normal anatomy change; fibrous connective tissue adhesion to vascular thickening, and not easy to identify. These can be caused by injury to blood vessels and cause bleeding during operation. The surgeon should be alert to this.

The judgment of tumor resectability is a problem that must be considered in operation. When the tumor has invaded the innominate vein or superior vena cava, or vascular wrapped around in tumor, or the tumor and surrounding tissue was frozen, you should take a cautious attitude, stop operation, only take a biopsy, were treated by radiotherapy. Although if the tumor and vascular adhesion invasion, but still can be gradually separated, dissected from the shallower to the deeper, from easy to difficult, to make it loose, free of tumor, finally removed in its pedicle clamp after.

For each fiber or anatomical process with cable shall be cut off to avoid damage to vascular clamp, increase the difficulty of operation. If accidental damage to blood vessels, should not blindly confound hemostatic forceps. First out the enemy break with gauze oppression, prepared suction, while speeding up the blood transfusion, blood sucking operation field, distinguish the location and extent of damage and then decide is clear, direct suture or repair.

From the side of the chest tumor protruding into the right side, or the tumor protruding to extend the neck, should be dissected under direct vision, sometimes some of the blood vessels through which, or the blood supply of tumor, blind blunt separation can cause bleeding, pericardial tumor invasion, can cut the pericardium in normal part extends into the pericardial cavity in finger help to remove the tumor or tumor resection and pericardium.

6 surgical treatment results either benign or malignant thymoma treatment, including surgery, only when the resection or resection of the thymoma failed to consider radiotherapy, chemotherapy of thymoma based micro.

The relationship between surgical resection rate and tumor size. Generally speaking, the lower the resection rate of tumor, the same as the general conclusion of tumor surgery, but the tumor size is not the only measure of surgical resection. Sometimes it is large enough to be removed, and smaller tumors cannot be removed. In addition to the size of the tumor, whether the tumor invasion, especially the invasion of peripheral blood vessels, such as vena cava, innominate vein, the severity of the aorta greatly affect the surgical resection rate. When the tumor around the blood vessel growth was frozen, even moderate size tumor, sometimes also cannot complete resection.

7 of the radiation therapy of malignant thymoma thymoma even visible has been removed, the tumor bed still need to be done, when the operation has clear residual tumor tissue was not cut or failed to net resection, to increase the dose, usually 60Gy (6000rad). Some benign thymoma also have a few suggestions on the recurrence of benign thymoma should also be anti irradiation 30 ~ 40Gy (3000 ~ 4000rad). The results are generally not radiotherapy for thymoma, very satisfied, because each report results far to review.

 

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