腹膜后巨大肿瘤的手术切除

Resection of giant primary retroperitoneal tumor

目的 :探讨腹膜后巨大肿瘤 (GPRT)手术切除的原则 ,提高手术效果。方法 :对 10 2例GPRT患者施以手术切除 ,术中注重对手术难点问题的解决与手术技巧的改进。结果 :其中完整切除肿瘤 92例 ,肿瘤完整手术切除率达 90 .2 % ;姑息性减瘤术 9例 ;仅行活检而放弃手术 1例 ;无手术死亡病例。术后获随访 89例 ,随访时间 6个月～ 9年 ,5年生存率为 4 3.6 %。结论 :手术切除GPRT是首选治疗方式 ;大血管与肿瘤的成功分离是达成手术彻底切除瘤体的关键 ;高质量的术前影像学检查 ,术中注意操作技巧的改进 ,能够显著提高GPRT的手术效果 ,减少手术导致邻近脏器的不必要丧失。

Objective:To study the difficulties and experience on the resection of giant primary retroperitoneal tumor (GPRT) in order to improve the surgical operation-based therapy.Methods:The clinical data of 102 patients with GPRT testified by post-operative pathological examination from 1995 to 2003 were retrospectively analyzed.Results:Tumors were benign in 19 and malignant in 83. Ninety two cases underwent complete resection, with incidental organ resection in 23, palliative resection in 9 and without resection but biopsy in 1. The ratio of complete resection is 90.2% and without death during operation.Conclusions:The surgical resection should be the first choice for GPRT cases. It is the key point to dissect major blood vessels from GPRT for complete resection. The higher complete resection rate and lower incidence of nearby important organs lost can be achieved by combination of high-quality pre-operative radiological examination with correct operative procedures.