Diagnosis and surgical treatment of mediastinal foregut cysts / 解放军医学杂志

ABSTRACT

Objective Foregut cyst of the mediastinum is an uncommon but important mediastinal disease,representing 40% to 50% of all the mediastinal cysts.The purpose of present study was to summarize the clinical feature and surgical treatment of mediastinal foregut cysts in patients admitted to the authors' hospital,and to emphasize the important role of video-assisted thoracic surgery(VATS)played in the treatment of mediastinal foregut cysts.Methods Data of 51 cases of mediastinal foregut cysts confirmed by pathological examination from 1993 to 2006 were retrospectively reviewed.Results 29 male and 22 female patients were involved in the present study.Among all the cases,24(47%)manifested no conspicuous symptom,and the remainders showed various symptoms such as chest pain,dyspnea,cough etc.The findings of magnetic resonance imaging(MRI)were more helpful than that of CT in diagnosis.In the present series,5 cysts were located in the antero-superior mediastinum,18 in the middle mediastinum and 28 in the posterior mediastinum.All patients underwent operation,including 15 minimal invasive surgeries such as VATS.35 cysts were excised completely and 16 cysts were resected partially.Pathological examination confirmed that,there were 42 bronchogenic cysts,7 esophageal cysts and 2 gastro-enterogenous cysts.There was no postoperative death or major complications,but minor complications occurred in 3 patients.During an average of 26 months of follow-up(ranged 2 to 56 months),no recurrence or malignant degeneration was found.Conclusion Mediastinal foregut cysts are rarely diagnosed definitely before operation,and it should be surgically treated because its pathology can only be established after surgical extirpation.Video-assisted thoracoscopic surgery is the first choice for the treatment of mediastinal foregut situated,especially for those situated in the middle and posterior mediastinum.