右上腹肿瘤联合脏器切除手术入路及手术技巧探讨

Analysis on surgical approaches and surgical skills of multi-visceral resection for the right upper quadrant tumor

目的探讨右上腹肿瘤联合脏器切除的手术入路及手术技巧的安全性和可行性。方法回顾2004年1月至2012年2月期间,郑州大学附属肿瘤医院普外科收治的21例右上腹肿瘤行联合脏器切除病人的临床资料。采用右下腹膜后逆行入路或(和)肝被膜下入路,分析术中出血量、手术时间及术后并发症情况。结果本组21例病人均行右上腹肿瘤联合脏器切除术,采用右下腹膜后逆行入路的病人17例,采用肝被膜下入路联合右下腹膜后逆行入路的病人4例,平均出血量为350mL,平均手术时间105min,其中18例术后恢复顺利,1例出现胰瘘,1例出现胆瘘,1例出现粘连性肠梗阻,经通畅引流及营养支持治疗后均痊愈出院,无一例死亡。结论右上腹肿瘤联合脏器切除采用右下腹膜后逆行入路和(或)肝被膜下入路是安全、可行的。

Objective To explore the safety and feasibility of surgical approaches and surgical skills of multi-visceral resection for the right upper quadrant tumor. Methods The clinical data of 21 patients with right upper quadrant abdominal tumor performed multi-visceral resection from January 2004 to February 2012 in Department of General Surgery, Henan Cancer Hospital were analyzed retrospectively. We used the lower right retroperitoneal retrograde approach or/and hepatic subcapsular approach, and analyzed blood loss, operative time and postoperative complications. Results Twenty-one patients underwent right upper quadrant tumor combined organ resection, 17 cases of patients with the use of the right lower peritoneal retrograde approach, 4 cases of patients with the use of hepatic subcapsular approach joint lower right retroperitoneal retrograde approach. The average blood loss was 350mL and the mean operative time was 105 min. Among all the patients, 18 patients recovered smoothly, 1 patient had pancreatic fistula, 1 patient had biliary fistula, 1 patient had intestinal obstruction, which were cured by the unobstructed drainage and nutritional support therapy with no death. Conclusion Surgical approaches and operative skills of multi-visceral resection for the right upper quadrant tumor are safe and feasible.