[Surgical treatment of tuberculous mediastinal adenopathies in childhood (author's transl)].
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Biomedical subjects
Publications and source records attributed to M Merlier.
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The authors review the various treatments of the Pancoast and Tobias syndrome and propose a new surgical approach in two stages. The first, cervical stage involves resection of the internal half of the clavicle and of the first rib and dissection of the vessels and nerves lying in the supraclavicular fossa, so that the tumour can be lowered in one piece and exposed. The second stage consists of posterolateral thoracotomy with exeresis of the lung. The wide cervicotomy has several advantages: the tumour can be biopsied for extemporaneous histological examination, and its extension to the lymph nodes, thoracic wall and mediastinum can be assessed; freeing the nerves relieves pain and considerably facilitates the second stage of the operation.
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From 96 surgical interventions in the child, the authors studied the repartition of tumours according to their histological nature, their benignity or malignancy. For each kind of tumour they gave its frequency and clinical, radiological and biological data. Above all they studied the distant results of these interventions with an important set back. The results are excellent for benign tumours and promising for malignant ones and enable the deduction of therapeutical indications.
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