右上腹非肝源性巨大肿瘤八例临床分析

Clinical Analysis of 8 Patients with Huge Nonhepatic Tumors in Right Upper Abdomen

目的总结右上腹非肝源性巨大肿瘤的诊疗经验。方法对我院收治的右上腹非肝源性巨大肿瘤8例的临床资料进行回顾性分析。结果本组6例影像学检查误诊为肝源性肿瘤,2例按右侧肾上腺和右上腹膜后巨大肿瘤行剖腹手术,术中不排除肝源性肿瘤。8例均行手术治疗,其中肝下下腔静脉侧壁部分切除、右肾脂肪囊完全切除各2例;联合半胃切除、胰十二指肠并横结肠切除、胰体尾胰管切断后胰肠吻合各1例;另1例病情反复,先后行3次手术,第3次术后1个月死亡。本组手术时间5.5~11.0 h,中位时间6.8 h;术中失血400~6000 ml,中位失血量2860 ml;术中输血0~5250 ml,中位输血量2750 ml。切除肿瘤直径11~30 cm,平均15 cm;肿瘤重960~5100 g,平均2605 g。恶性肿瘤7例,恶性潜能未定性肿瘤1例。1次手术后1年存活率100.0%,2年存活率50.0%,3年存活率37.5%。1例存活已超过5年,至今体健。结论右上腹非肝源性巨大肿瘤与肝脏关系密切,易误诊为巨大肝脏肿瘤,对其影像学表现进行仔细分析并积极手术治疗,效果满意。

Objective To summarize the experience in diagnosis and treatment of huge nonhepatic tumors in the right upper abdomen.Methods The clinical data of 8 patients with huge nonhepatic tumors in the right upper abdomen treated in our hospital were retrospectively analyzed.Results 6 patients were misdiagnosed as hepatic tumors by imaging examination,and 2 patients who underwent celiotomy were misdiagnosed as huge nonhepatic tumor in right adrenal glands and right up peritoneum respectively.hepatic tumors were not excluded.All the eight patients underwent surgical therapy,including partial resection of lateral muralium of the infrahepatic vena cava in 2,complete removal of adipose capsule in right kidney in 2,combined hemigastrectomy in 1,pancreatoduodenectomy plus transverse colectomy in 1,transaction of pancreatic duct of body and tail of the pancreas and pancreaticojejunostomy in 1.One patient had tumor relapse postoperatively and died one month after the third operation.The median operative time was 6.8 h（5.5~11.0 h）,median intraoperative blood loss was 2860 ml（400~6000 ml）,and median intraoperative volume of blood transfusion was 2750 ml（0~5250 ml）.The average diameter of the resected tumor was 15 cm（11~30 cm）,average tumor weight was 2605 g（960~5100 g）.There were 7 malignant tumors and 1 malignant potential undifferentiated tumor.The 1,2,3 year survival rates after a surgery were 100.0%,50.0%,and 37.5%,respectively.One patient has survived for more than 5 years.Conclusion Huge nonhepatic tumor in the right upper abdomen is closely related to the liver and tends to be easily misdiagnosed as hepatic tumor.Such patients may have satisfactory prognosis if their imaging features are carefully analyzed and active sugical treatment is undertaken.