Kravchuk B. Current approaches to diagnosis and surgical treatment of benign tumors of the mediastinum in children

Author analysed diagnosis and treatment results of 294 patients with benign mediastinal tumours. There were 165 (56.1 %) thymic tumours, 68 (23.1 %) neurogenic tumours, 25 (8.5 %) teratodermoid masses, 7 (2.4 %) mesenchymal formations and 29 (9.9 %) mediastinal cysts. There are two types of clinical course of benign mediastinal tumours: asymptomatical and typical. At typical course two periods were found: the period of vague symptoms and period of distinct symptoms. There were determined five complexes of symptoms depending on organ compression: respiratory, neurogenic, osteogenic, haemodynamic, dysphagic. In case of respiratory tract compression during asymptomatic period, in the pathogenesis of respiratory diseases period dim organ symptoms, "local immobilization" was defined as the first step of airway compression and a trigger of respiratory syndrome. Radiographic and endoscopic classification of airway stenosis in children with benign tumours were carried out based on the pathogenic mechanisms. Mediastinal compression syndrome in children with benign lesions of mediastinum is heterogeneous by nature and is the main component of early diagnosis. The respiratory syndrome is the main syndrome (79,6 %). Early radiography in is the main diagnostic tool and CT, MRI and ultrasound scanning are supplementary. The new methods of diagnosis were developed: computed pneumomediastynotomography and remote infrared thermography. The latter is highly informative, not invasive, simple, cheap, safe and proposed as a screening method for early diagnosis of neurogenic sympathetic trunk tumoursn.Surgical removal of benign mediastinal tumours is the only radical treatment. Author operated on 150 (51.0 %) patients, including 13 (8.7 %) reoperations. Thoracotomy was carried out in 137 (91.3 %) cases as the most rational access to the tumour. Sternotomy was used in 8 (5.3%) patients. Surgical interventions were radical in 117 (78.0%) patients; combined – in 19 (12.7%); paliative – in 14 (9.3 %) cases. Original methods of surgical treatment of mediastinal tumours with high–frequency electric live tissue welding and tumour site plasty were handled.The complex usage of the high-frequency electric live tissue welding has reduced the volume of intraoperative blood loss by 53.5 %, and reduced the time of surgery by 12.8 %, and in combination with tumour site plasty with mediastinal pleural flap reduced the postoperative exudation from 25 % to 5 %.