腹膜后软组织肉瘤复发的再手术治疗:附25例报告

Surgical treatment of recurrent retroperitoneal soft tissue sarcoma:report of 25 cases

目的探讨复发性腹膜后软组织肉瘤的诊断和再手术治疗。方法回顾性分析收治的手术后复发并再次手术的25例复发性腹膜后软组织肉瘤的临床资料。结果25例复发性腹膜后软组织肉瘤均经手术及病理证实,因多次复发（1～5次,平均1.68次/例）,共行手术42次,包括完整切除26次,部分切除11次,探查活检5次。手术中联合脏器切除共19例,合并大血管切除共5例。末次术后1,3,5年生存率分别是52.0%,40.0%,28.0%。累及重要血管的肿瘤的完整切除率（35.7%）比未累及重要血管（75.0%）者明显降低（P=0.013）,而肿瘤是否累及临近脏器对手术完整切除率没有影响（P=0.462）。结论影像学检查对术前评估和手术切除范围有重要意义。对于复发性腹膜后软组织肉瘤,只要无明显手术禁忌,就应积极予以手术切除。

Objective To explore the diagnosis and re-operation of the recurrent retroperitoneal soft tissue sarcoma（RPS）.Methods Clinical data of 25 patients with recurrent RPS were retrospectively analyzed.Results All of 25 cases of recurrent RPS were diagnosed by operation and postoperative pathologic examination.They underwent a total of 42 time operations,with mean time of re-operations was 1.68.Of the 42 time operations,26 time were complete resection,11 time partial resection and 5 time only biopsy.A total of 19 cases underwent removal of contiguous intra-abdominal organs and 5 underwent resection of major invaded blood vessel.The 1-,3-and 5-year survival rate of recurrent RPS was 52.0%,40.0% and 28.0% respectively.The rate of complete resection in recurrent RPS with major blood vessel invasion was 35.7%.In contrast,the complete resection rate in recurrent RPS without major blood vessel invasion was 75%（P=0.013）.On the other hand,there was no significant difference in complete resection rate between the recurrent RPS with adjacent organs invasion and the recurrent RPS with no adjacent organs invasion（P=0.462）.Conclusions Preoperative imaging results are crucial factor for assessment of operative resectability.Unless there are obvious comtraindications,recurrent RPS should undergo aggressive surgical excision.