原发性腹膜后肿瘤累及下腔静脉13例外科治疗

Surgical treatment of 13 cases of primary retroperitoneal tumor involving inferior vena cave

目的探讨原发性腹膜后肿瘤累及下腔静脉(IVC)时的手术处理方法。方法回顾性分析和总结2000年9月至2005年4月的13例原发性腹膜后肿瘤累及IVC的患者均采用经腹切口径路肿瘤切除及IVC受累部分血管处理的经验。结果本组肿瘤患者中恶性11例,良性2例。11例恶性肿瘤完整切除,其中2例是复发再次手术。2例良性肿瘤完整切除,合并脏器切除12例。全组无手术死亡。IVC受累部分血管处理采用以下几种方法,2例单纯缝合术,4例端端吻合术,1例单纯结扎术,6例血管重建术。生存期>1年者11例(84.6%),生存期>2年7例(53.8%),随访过程中2例(15.4%)肿瘤复发再次切除。结论累及IVC的原发性腹膜后肿瘤的外科治疗要有充分的术前准备、仔细的手术操作和妥善的术后处理才能提高切除率、降低复发率,延长存活时间。

Objective To explore the surgical treatment of primary retroperitoneal tumor involving inferior vena cava （PRTIIVC）. Methods The clinical data of 13 patients with PRTIIVC receiving tumor resection through abdomen incision and IVC involved from September 2000 to April 2005 were retrospectively analyzed. Results Eleven cases of malignant primary retroperitoneal tumor （PRT） and 2 cases of benign PRT were diagnosed by operation and postoperative pathologic examination. Eleven cases of malignant PRT underwent complete resection with 2 cases of recurrent malignant PRT. Two cases of benign PRT underwent complete resection. Twelve cases underwent adjacent organ resection. No operation death occurred in these cases. The treatment methods for IVC involved were as follows ,2 cases undergoing simple suture,4 cases undergoing end-to-end anastomosis, 1 case undergoing simple ligature ,6 cases undergoing reconstructive vascular operation. Life span of 11 cases（84. 6% ） exceeded 1 year,life span of 7 cases（53.8% ） exceeded 2 years,and 2 cases （ 15.4% ） of recurrent tumor underwent reoperation. Conclusions In the surgical treatment of PRTIIVC, sufficient preoperative preparation,elaborative operative procedure and well arranged postoperative treatment are the keys of raising the rate of resection, reducing the recurrence rate and extending the survival time.