儿童腹膜后肿瘤累及重要血管的手术处理

Operative Experiences of Retro-peritoneal Tumors with Invasion to Large Vessels in Children

目的总结儿童常见腹膜后肿瘤累及重要血管时的手术处理经验。方法选择47例儿童腹膜后肿瘤,其中包括进展期神经母细胞瘤22例,神经节细胞瘤6例,肾母细胞瘤19例,应用"血管骨骼化"的方法解剖血管,并对受累血管采用多种方法处理,最终完成一期手术切除。结果儿童常见腹膜后肿瘤如神经母细胞瘤、肾母细胞瘤、神经节细胞瘤在血管骨骼化理念的指导下,一期手术完全切除率分别达95.45%、100%及100%。除1例术后早期发生急性肾功能衰竭经透析治疗痊愈外,其余均顺利恢复,无围手术期死亡病例。结论儿童常见腹膜后肿瘤通过骨骼化血管及其它相应方法处理后,能提高一期手术完全切除率。

Objective To study the operative experiences of retro-peritoneal tumors commonly seen in children with invasion to large vessels. Methods 47 eases of childhood retro-peritoneal tumors including 22 cases of neuroblastoma, 6 cases ofgangliocytoma and 19 eases ofWihn＇s tumor, obtained one stage gross total resection with the guide of Vascular Skeletalization and multiple manipulation of related vessels. Results Guided by the concept of vascular skeletalization, retro-peritoneal tumors of children received one-stage gross total resection and the resection rates were 95.45% in neuroblastoma, 100% Wilm＇s tumor and gangliocytoma, respectively. There were no operative death, no serious complications hut only one needed dialysis cause of the early post-operatively acute renal failure. Conclusions Guided by the concept of vascular skeletalization together with other manipulation of vessels, it is possible for surgeons to fulfill gross total resection of the childhood retro-peritoneal tumors in one stage.