复杂性腹膜后肿瘤联合脏器切除的若干问题

Resection of adjacent viscera for complex retroperitoneal tumor

腹膜后肿瘤常侵犯邻近脏器或与邻近脏器紧密粘连,尤其是高度恶性的腹膜后软组织肉瘤以及复发性肿瘤。对此类复杂性腹膜后肿瘤往往需要行联合脏器切除,来达到降低局部复发、提高存活率的目的。术前应进行充分的影像学评估,术中需对肿瘤完整切除可能性作出准确的判断。采取中线区重要血管旁入路以及先分离受累脏器再进行肿瘤和脏器联合整块切除的方法,不仅解剖清晰、R0切除的成功率较高,而且可防止脏器副损伤、避免或减少大出血的发生。

Retroperitoneal tumors, especially highly malignant retroperitoneal soft tissue sarcomas and recurrent tumors, often involve adjacent viscera by infiltrative pattern or by expansive pattern. Extended surgery with resection of adjacent viscera is recommended to control local recurrence and improve survival. Resectability should be carefully evaluated preoperatively by computed tomography scan and at surgical exploration. The frontline aggressive surgical approach and the way of en bloc resection have many advantages such as clear anatomic approach, high success rate of R0 resection, less concomitant damage of organ, and less bleeding in the operation.