右上腹非肝源性巨大肿瘤的手术治疗

Surgical resection of huge non-hepatic tumors in the right upper quadrant of abdomen

目的探讨右上腹非肝源性巨大肿瘤的诊治。方法回顾分析我院2004年5月至2009年12月收治的9例右上腹非肝源性巨大肿瘤患者的临床资料。结果9例中7例术前影像学诊断未能区分肿瘤为非肝源性，2例术中不能除外肿瘤是否来源于肝脏。9例肿瘤均手术切除，其中联合半胃切除1例，肝下下腔静脉侧壁部分切除2例，右肾脂肪囊完全切除2例，胰十二指肠、横结肠切除1例，胰体尾胰管切断后胰肠吻合1例。手术历时318～660rain，中位时间390rain。术中失血量4。0～6000ml，中位失血量2560ml；术中输血量0～5250ml，中位输血量2450ml。切除肿瘤直径11～30cm，平均为14．5cm；切除肿瘤重量960～5100g，平均为2465g。恶性肿瘤8例，恶性潜能未定肿瘤1例（胰腺实性假乳头状瘤）。术后胰漏1例，无严重并发症和手术死亡。术后5个月复发1例。术后1年存活率100％，2年存活率56％，3年存活率33％。1例患者存活已超过5年。结论右上腹非肝源性巨大肿瘤与肝脏关系密切，易被误诊为巨大肝脏肿瘤。应仔细分析其影像学特征，正确区分肿瘤是否为非肝源性并予积极手术治疗。此类肿瘤手术切除率高，治疗效果令人满意。

Objective To study the pathology and treatment of huge nonhepatic tumors in the right upper quadrant of abdomen. Methods The clinical data of 9 patients with huge nonhepatic tumor in the right upper quadrant of abdomen treated surgically at our hospital from May 2004 to December 2009 were retrospectively analyzed. Results Preoperative imaging failed to define the tumors as non- hepatic in original in 7 patients and operation failed to recognize the origin of the tumors in 2 patients. All the tumors were successfully resected, with combined hemigastectomy in 1 patient, partial resec- tion of the lateral wall of the infrahepatic vena cava in 2, complete resection of adipose capsule of the right kidney in 2, pancreatoduodenectomy plus transverse colectomy in 1, and transection of pancreatic duct of the body and tail of the pancreas and pancreaticojejunostomy in 1. The median operation time was 390 min （318--660 rain）. The median intraoperative blood loss was 2560 ml （400--6000 ml）. The median intraoperative blood transfusion was 2450 ml （0 5250 ml）. The average diameter of the resected tumor was 14.5 cm （11 30 em）, and the average tumor weight was 2465 g （960--5100 g）. Postoperative pathological diagnoses showed that 8 patients had malignant tumors and 1 had a poten- tially malignant and undifferentiated tumor （solid pseudopapillary tumor of pancreas）. Perioperative pancreatic anastomotic leak occurred in 1 patient, and there were no severe postoperative complications and operative death in this series. Tumor recurrence was detected 5 months following operation in 1 patient. The 1-, 2-, 3-year survival rates were 100%, 56%, 33%, respectively. One patient survived for more than 5 years. Conclusions Huge non-hepatic tumors in the right upper quadrant of abdomen could easily be misdiagnosed as hepatic neoplasms. The surgical resection rate was high. The prognosis for patients who received resectional treatment was satisfactory.