老年人原发性腹膜后肿瘤的外科处理

Surgical treatment of primary retroperitoneal tumors in the elderly

目的 评价老年人原发性腹膜后肿瘤外科处理的可行性和结果.方法 对1988年1月至2013年11月间手术治疗的38例老年人（中位年龄65.6岁;范围62～79岁）腹膜后肿瘤患者的肿瘤组织学类型、手术特点和结果进行分析.结果 常见临床症状和体征为腹痛和腹胀、腹部包块、下肢疼痛和麻木、下肢水肿、便秘和尿频.部分患者无症状.CT和MRI检查准确率均为100％.本组患者共有并存疾病46例次,包括高血压、缺血性心脏病、糖尿病、慢性支气管炎、阻塞性肺气肿和心律失常等.38例共行手术45例次（包括7例局部复发再手术）,其中肿瘤完全切除29例次（64.4％）,联合受累邻近脏器和（或）血管整块切除8例次（17.8％）,部分切除3例次（6.7％）,因无法切除而仅行活检5例次（11.1％）.良性肿瘤18例,恶性肿瘤20例.术中和术后并发症发生率分别为11.1％（5/45）和26.7％ （12/45）.术后早期（＜30 d）主要并发症为腹腔出血1例、淋巴漏1例、胰漏1例、腹腔感染1例、肺部感染2例、胸腔积液1例、胃瘫1例、心律失常1例、切口感染2例、切口裂开1例.并发症均获治愈.围手术期无死亡病例.结论 高龄不是原发性腹膜后肿瘤的绝对禁忌证,恰当的术前评估、缜密的手术预案、细致的手术技术和精细的围手术期管理对保证老年人原发性腹膜后肿瘤切除的可行性和安全性是必须的.

Objective To evaluation the feasibility and outcomes of surgical treatment of prima ry retroperitoneal tumors （PRTs） in the elderly.Methods Between January 1988 and November 2013,surgical resection was attempted in 38 elderly patients with PRT（meadian age：65.6 years; range 62 to 79）.The histological type of the tumors,oprating charecteristics,and outcomes were an alyzed.Results Patients usually present with abdominal mass,pain and distention,leg pain and numbness,leg edema,urinary urgency,and constipation or may be asymptomatic.The accurate rate of CT scan and MRI for the tumor was 100％ respectively.38 patients had a total of 46 combined dis ease,including hypertention,ischemic cardiopathy,diabetes,chronic bronchitis,obstructive pulmo nary emphysema,and arrhythmia.Of the 38 patients,a total of 45 operations including 7 further re sections for local recurrence were done,among these,29 underwent complete tumor resection （64.4％）,8 concomitant resection of involved adjacent viscera organ and/or vessel structure（en bloc） （17.8％）,3 Partial resection（6.7％）,and 5 introperative biopsy（11.1％,unresectable）.Benign le sions were found in 18 patients and malignancies in 20.The incidence of the intr-and postoperative complication was 11.1％（5/45） and 26.7％ （12/45） respectively.The main postoperative early （＜30 days） complication was abdominal bleeding（one patient）,lymphatic fistula（one）,pancreatic fistula （one）,intr-abdorminal infection（one）,pulmonary infection（two）,hydrothorax（one）,gastric paral ysis（one）,arrhythmia（one）,infection of incisional wound（two）,and disruption of wound（one）,re spectively.All complications get recovered,and there was no per-operative mortality.Conclusions The older age can not be absolute contraindication for PRT surgical resection.Appropriate preopera tive evaluations,detailed surgical planning,meticulous surgical techniques and detailed perioperative management are mandatory to guarantee the feasibility and safety of PRT resection performed in the elderly.