腹膜后肿瘤术中腹主动脉及下腔静脉的切除与重建

Excision and reconstruction of abdominal aorta and inferior vena cava in the treatment of retroperitoneal tumors

目的探讨累及腹主动脉及下腔静脉的腹膜后肿瘤切除时,受累血管的切除与重建的最佳方法。方法回顾性总结1990年1月至2003年6月33例累及腹主动脉及下腔静脉的腹膜后肿瘤的手术切除及血管重建的临床资料。结果全部病人均成功实施了肿瘤完整切除,包括受累血管的切除与重建,无手术死亡。随访29例,其3、5年存活率分别为60·1%和40·6%,平均存活期为53·9个月。结论累及腹主动脉及下腔静脉的腹膜后肿瘤不是根治性切除的手术禁忌证,腹主动脉及下腔静脉的切除与重建术,安全、有效、可行;重建腹主动脉及下腔静脉可以提高肿瘤的切除率,降低局部复发率,延长病人存活时间。

Objective To explore the surgical manipulation of abdominal aorta （AO） and inferior vena cava （IVC） invaded by retroperitoneal tumors （RPT） in order to raise the resection rate and improve the operative safety. Methods From January 1990 to June 2003,33 cases of AO and IVC invaded by retroperitoneal tumors were performed excision and reconstruction of affected AO and IVC in the General Hospital of PLA. The clinical data of 33 cases was analyzed retro- spectively. Results All the cases were performed excision of tumors en bloc including the excision and reconstruction of affect blood vessels. No one was died in the operation. Twenty-nine cases were followed up. The 3-year and 5-year survival rate were 60. 1% and 40. 6% respectively. The average survival time was 53.9 months. Conclusion RPT involving AO and IVC is not contraindication for surgical resection. The tumor and the affected vessel can be removed en bloc followed by vascular reconstruction. It can decrease the local recurrence rate and prolong survival time.