原发性盆部腹膜外肿瘤84例的外科治疗

Surgery for extraperitoneal pelvic neoplasms

目的 探讨原发性盆部腹膜外肿瘤的外科治疗经验及技巧。方法 回顾性分析原发性盆部腹膜外肿瘤 84例临床资料 ,其中良性 33例 ,低度恶性 33例 ,高度恶性 18例。术前 6例行血管造影并髂内动脉栓塞。经腹、经骶及位腹骶入路切除者分别 5 8、16、10例。结果 84例均进行手术治疗 ,其中 1例半年内 4次手术切除肿瘤。 6 8例达肿瘤全部切除 (81% ) ,其中良性肿瘤切除率为 94 %(31/33)。行盆腔脏器联合切除者 35例 ,其中全盆腔脏器切除 2例、前盆腔脏器切除 2例。行髂总、髂外血管切除共 5例 ,均行人造血管移植 ;髂内动脉结扎 10例。术中出血最多 15 0 0 0ml,平均 2 385ml。切除肿瘤最大 30cm× 30cm× 2 5cm ,无手术死亡 ,并发症发生率 7% (6 /84 )。术后 37例获随访 ,平均随访 5 4个月 ,仅 1例死亡 ,2 1例复发者再行 2 2例次手术 ,其中 1例术后多次复发共行 7次手术存活12年。结论 联合切口及联合脏器切除 ,必要时行髂血管移植 ,分次切除及复发后再切除 。

Objective To evaluate the methods of surgery for extraperitoneal pelvic neoplasms. Methods Clinical data related to surgery of 84 cases of extraperitoneal pelvic neoplasms were extracted and retrospectively analyzed. Results All 84 patients underwent operations, including one of them who received 4 operations within 6 months for resection of a single tumor. 58 abdominal, 16 buttock and 10 combined incisions were made in the series. Pelvic organs and structures were co-resected in 35 cases, including total pelvic exenteration in 2 cases and anterior pelvic exenteration in 2 cases. Common and/or external iliac vessels were resected and transplantations of artificial vessel were carried in 5 cases. Internal iliac arteries were ligated in 10 cases. The mean blood lose was 2 385 ml in our series and the largest was 15 000 ml. The complete resection rate of tumor was 81% for 84 operations and the largest resected tumor was 30 cm×(30 cm×25 cm.) There was no hospitalized death, and postoperative complication rate was 7% (6/84)in our series. Only 1 death were seen during the mean period of postoperative follow-up of 54 months, 22 operations were carried for 21 cases of recurrence, including 7 operations for 7 recurrences in a case within 12 years. Conclusions Making adequate abdominal or/and buttock incisions, exenterations of involved pelvic organs and structures, total pelvic exenteration if necessary, appropriate management of iliac vessels, planned re-operation for one tumor, and re-operation for recurrences are important methods for the treatment of extraperitoneal pelvic neoplasms.