经膀胱入路行膀胱受侵的复杂盆腔肿瘤切除临床效果观察

Resection of the pelvic tumors with bladder invasion through trans-bladder approach

目的 探讨膀胱受侵的复杂盆腔肿瘤切除的手术入路方法. 方法 回顾性分析2007年10月至2010年10月12例膀胱受侵的复杂盆腔肿瘤患者资料.男8例,女4例.年龄35～65岁.肿瘤直径≥10 cm且＜16 cm者3例,≥16 cm者9例；肿瘤分期均为T4N0M0.手术均经膀胱入路,进入盆腔肿瘤下缘,并逆行向上将肿瘤与骶前、盆壁及盆腔脏器分离,完整切除盆腔肿瘤.总结12例患者围手术期及随访情况. 结果 12例手术时间110～150 min,中位时间126 min;术中出血量300～1200 ml,中位出血量521 ml；住院时间14～28 d,中位时间为22 d.围手术期患者无死亡.术后病理：胃肠间质瘤3例（属高危险度）、恶性畸胎瘤2例、恶性神经鞘瘤3例、子宫平滑肌肉瘤4例,手术切缘均为阴性.10例随访6～48个月.3例死于肿瘤复发、转移. 结论 经膀胱入路在复杂盆腔肿瘤切除术中的应用能有效提高肿瘤切除率,降低手术风险.

Objective To study the trans-bladder operative approach in resection of the complicated pelvic tumors with bladder invasion. Methods Twelve patients with complicated pelvic tumors were ana- lyzed from Oet. 2007 to Oct. 2010. There were 8 males and 4 females. Patient＇s age was ranging from 35 to 65 years. There were 3 patients with tumor diameter from 10 to 16 cm and 9 patients with tumor diameter greater than 16 cm. All the tumors were located in the pelvic and the stage of all tumors was T4NoM0. The technology of trans-bladder to approach the lower edge of the pelvic tumor and then retrograde up to remove the tumor out of the presacral tissue, pelvic wall, and pelvic organ was applied. The length of hospital stay, operative time, blood loss, death during peri-operative period and the post-operative survival were analyzed retrospectively. Results The median operative time was 126 （110-150） min. The median blood loss was 521 （300-1200） ml. The median hospital stay was 22 （14-28） d. No patient died after surgery. Ten pa- tients were followed up for 6 to 48 months. Three cases died of metastasis or recurrence. Conclusion With the trans-bladder operative approach, the resection of pelvic retroperitoneal tumors is effective and safe.