肿瘤侵犯大血管的外科治疗

Surgical treatment of major vessels invaded by tumor

目的 探讨累及大血管的肿瘤切除及受侵犯血管的处理方法 ,以提高肿瘤的切除率及术后生存率。方法 总结 1998年 10月～ 2 0 0 4年 2月的 2 6例累及重要血管的肿瘤切除及血管重建的经验。结果 2 6例患者均无术后人工血管感染 ,血肿形成等。获随访 2 3例 ,随访时间 2～ 65个月 ,平均 42 .8个月。术后随访分别行彩色超声或CT血管显影 (CTA )检查 ,5例胰头癌和 1例胆管癌患者下腔静脉、门静脉置换后 ,3例分别于术后 3～ 15个月并发癌栓形成 ,术后远期通畅率为 5 0 % ,肿瘤分别于术后 3～ 3 1个月复发。 7例盆腔和腹膜后肿瘤切除血管置换患者术后获随访 2年 ,1例复发 ,但血管通畅。 2例四肢肉瘤患者随访 1年未见复发 ,血管通畅。 11例颈部肿瘤切除、血管置换患者术后随访 3个月至 5年 ,目前血管通畅 ,肿瘤未见复发。结论 对累及重要血管的肿瘤患者行肿瘤切除并大血管切除重建手术是安全的 ,可明显提高切除率、降低复发率 ,延长存活时间。

Objective To study the surgical treatment of major blood vessels invaded by tumors in order to raise the resection rate and postoperative survival rate. Methods Clinical data were analyzed on 26 patients undergoing (resection) of tumors along with reconstruction of major blood vessels from October 1998 to February 2004. Results Tweety-three cases were followed up for 2～65 months with median 42.8 months. Doppler ultrosonography and CTA examination were performed respectively during the follow-up process.In 5 patients with carcinoma of the head of pancreas who had inferior vein cava replaced and in 1 patient with cholangiocarcinoma who had portal vein replaced,3 were complicated with carcinoma embolism formation at 3,12 and 15 months respectively after surgery,(postoperative) graft patency was 50%;all of the 6 patients had recurrence of the tumor at 3,6,8,12,24 and 31 months respectively after surgery.Seven patients with tumor in pelvic cavity or in posterior space of peritoneum were followed up for about 2 years,1 of them had tumor recurrence ,but the graft kept patent,2 patients with sarcoma in the limbs were followed up for 1 year without tumor recurrence or vessel obstruction.Eleven patients with tumors in the neck were followed up for 3 months to 5 years without tumor recurrence or vessel obstruction. Conclusions (Combination) of resection of neoplasm and reconstruction of major blood vessels is safe,effective and practical method for patients with major wessels invaded by tumor.