肿瘤侵犯重要血管的外科治疗

Surgical treatment of tumor invading important vessel

目的总结利用血管外科技术成功切除侵犯重要血管肿瘤的初步经验。方法共收治77例肿瘤侵犯重要血管的患者,其中位于胸腔13例,包括下腔静脉平滑肌肉瘤2例、胸腺癌3例、恶性胸腺瘤4例、上纵隔恶性精原细胞瘤1例、恶性淋巴瘤1例、肺癌2例;位于腹部23例,包括肾肿瘤合并下腔静脉癌栓11例、腹膜后炎性假瘤4例、腹膜后恶性纤维组织细胞瘤1例、腹膜后非何杰金恶性淋巴瘤1例、后腹膜淋巴结转移2例;右肾上腺副节瘤1例、壶腹癌1例、腹段下腔静脉平滑肌肉瘤1例、盆腔及下腔静脉平滑肌肉痛1例、盆腔纤维肉瘤1例;位于四肢6例,包括股骨成骨肉瘤3例、左髂窝血管内皮肉瘤1例、左上肢神经纤维瘤1例、双侧腹股沟淋巴瘤1例;位于颈部33例、包括颈动脉体瘤32例、神经纤维瘤1例。瘤体同时累及胸腹部者1例,为腹膜后恶性神经母细胞瘤侵入下腔静脉全程,瘤体同时已侵占右心房2/3。结果 72例瘤体完全切除,完全切除率93.5%,5例(6.5%)姑息性切除,无手术死亡,围手术期死亡4例。需行人工血管置换者13例,需行血管成形关闭者22例,颈部肿瘤需用颈动脉转流管者18例,其中良性肿瘤均无死亡,生存半年以上者90.4%,生存1年以上者84.9%。结论利用血管外科技术可大大提高肿瘤切除率,并提高生存率。

Objective To sum up preliminary experience of successful resection of tumor involving important vessel in 77 cases. Methods Seventy-seven cases were treated in this series including 47 cases in male and 30 cases in female. The ages ranged from 18 to 75 years with the average of 57. The tumor involving thoraco-abdominal cavity was in one case with malignant neuroblastoma. The tumor from retro- peritoneum invaded into the whole inferior vena cava （ IVC）, and into two-thirds of the right atrium. Tumor located in thoracic cavity were in 13 cases including IVC leiomyosarcoma in 2 cases, thymic carcinoma in 3 eases, malignant thymoma in 4 cases, malignant seminoma of superior mediatinum in 1 case, malignant lymphoma in 1 case, lung cancer in 2 cases. The tumor located in abdominal cavity were in 24 cases including renal carcinoma with tumor thrombi in 11 cases, inflammatory pseudotumor of retro-peritoneum in 4 cases, malignant fibrous histiocytoma of retro-peritoneum in 1 case, non-Hodgkin＇s disease of retro- peritoneum in 1 case, lymph metastasis of retro-peritoneum in 2 cases, paraganglion tumor of the right adrenal gland in 1 case, ampullary carcinoma in l case, leiomyosarcoma of abdominal IVC in 1 case, leiomyosarcoma of pelvic cavity and IVC in 1 cases, fibrosarcoma of pelvic cavity in 1 case. Tumor located in four extremities in 6 cases including osteogenic sarcoma in 3 cases, vascular endotheliosarcoma of the left iliac fossa in 1 case, fibroneuroma of the left upper extremity in 1 case, lymphoma of double groin in 1 case. Tumor located in neck in 33 cases including carotid body tumor in 32 cases and fibroneuroma of the left upper extremity in 1 case. Results Complete resection of tumor was in 72 cases, with a rate of 93.5%, palliative resection of tumor was in 5 cases with a rate of 6. 5%. No operative death occurred. Four eases died during peri-operative period. Reconstruction of involving vessel with vascular graft was in 13 cases, and shaping or patch closure of vessel was applied in 22 cases. Temporary shunt of carotid artery for neck tumor was used in 18 cases. No death occurred for benign tumor. The survival rate more than haft year was 90. 4%, and more than one year was 84. 9%. Conclusion The radical resection rate for tumor involving important vessel may be improved with the help of vascular technique.