经Trapdoor入路手术切除儿童颈胸交界处肿瘤的临床研究

Clinical Study of Trapdoor Approach for Surgical Resection of Cervicothoracic Junction Tumors in Children

摘要: 目的：探讨Trapdoor入路在儿童颈胸交界处肿瘤手术中的应用价值。方法：回顾性分析重庆医科大学附属儿童医院2022年1月至2024年10月经Trapdoor入路行颈胸交界处肿瘤切除术的患儿临床资料。结果：共纳入15例，中位年龄52个月，男性占40%，肿瘤多数位于左侧(11/15)。术前影像学检查均提示肿瘤累及邻近重要结构组织，所有患儿均选用Trapdoor入路进行手术，其中12例予以完整切除。平均手术时间270 ± 91 min，出血量30 (20, 100) ml，术后监护室停留时间3 (2, 4) d，平均呼吸机使用时间2.0 (1.0, 3.0) h，术后24 h引流量159 ± 117 ml，术后平均住院时间17.00 ± 4.41 d。术后病检提示神经母细胞瘤6例(其中2例为腹膜后肿瘤远处转移性瘤)，淋巴瘤3例，肾外横纹肌样瘤1例，脂肪母细胞瘤3例，脂肪瘤1例，骨外尤文氏肉瘤1例。所有患儿围术期无死亡，中位随访15个月，未见肿瘤复发及转移。结论：Trapdoor入路在颈胸交界处肿瘤的手术应用中有着较好的优越性，可以提供良好的视野，术中能够最大限度安全地切除肿瘤并且有着较低的并发症发生率。

Abstract: Objective: To explore the clinical value of the Trapdoor approach in the surgical management of cervicothoracic junction tumors. Methods: A retrospective analysis was conducted on the clinical data of patients who underwent cervicothoracic junction tumor resection via the Trapdoor approach at our center from Jan. 2022 to Oct. 2024. Results: 15 patients were included, with a median age of 52 months and a male predominance of 40%. Most tumors were located on the left side (11/15). Preoperative imaging revealed tumor involvement of adjacent critical structures. All patients underwent the Trapdoor approach, with complete resection achieved in the majority (12/15). The average operative time was 270 ± 91 min, the amount of blood loss was 30 (20, 100) ml, the postoperative stay time in the ICU was 3 (2, 4) d, the median ventilator use time was 2.0 (1.0, 3.0) h, the postoperative drainage volume was 159 ± 117 ml, and the average postoperative hospital stay was 17.00 ± 4.41 d. Postoperative pathology identified neuroblastoma in 6 cases (including 2 distant metastasis from retroperitoneal tumors), lymphoma in 3, extrarenal rhabdoid tumor in 1, lipoblastoma in 3, lipoma in 1 and extraosseous Ewing sarcoma in 1. No perioperative mortality occurred. During a median follow-up of 15 months, no tumor recurrence or metastasis was observed. Conclusion: The Trapdoor approach demonstrates significant advantages in the surgical treatment of cervicothoracic junction tumors, offering excellent visualization, maximal safe tumor resection, and low complication rates.