腹膜后肿瘤手术治疗的经验

Surgical experience in primary retroperitoneal tumor

目的 探讨原发性腹膜后肿瘤手术切除的方法 ,以提高肿瘤切除率。方法 结合 1990～ 1999年收治的 197例原发性腹膜后肿瘤 ,就其手术处理与经验教训进行讨论。结果 第 1次手术肿瘤全切除 15 4例 ,占 78% ,其中良性肿瘤全切除率为 93% ,恶性肿瘤全切除率为 6 7% ,术后 1～ 2年生存率分别为 70 .2 %和 6 3.3% ,而姑息切除和探查活检者均在 1年内死亡。术后复发再次手术 9例 ,其中 7例均作全切除术。联合脏器切除 17例 ,第 1次手术 11例 ,第 2次手术 6例 ,再手术完整切除率 75 .6 %。结论 术野开阔 ,层次清晰 ,是腹膜后肿瘤手术应具备的基本条件。原则上应作肿瘤完整切除 ,肿瘤与受累脏器应联合切除。对术后复发的肿瘤 ,完整切除是提高生存率的关键。

Objective To investigate the strategy of surgical resection in primary retroperitoneaol tumor for improving resectable rate. Methods 197 patients with primary retroperitoneol tumors were admitted and treated between 1990 and 1999. The surgical management and experience variables were analyzed for disease specific and disease free survival. Results 154 retroperitoneal tumors (78%) were completely resected in their first surgery. The complete resection rate of benign tumor was 93% and that of malignant tumor 67%.The survival rate of 1 year and 2 year post operation was 70.2% and 63.3% respectively. The patients with palliative resection or biopsy died totally within 1 year. Of the 9 recurrent patients undergoing re operations, 7 received complete resection. Among the 17 patients with the tumor and adjacent organs being radically excised, 11 patients were operated in first surgery and the remaining 6 patients were in their second operations. The complete resection rate of re operation was of 75.6% . Conclusions A wide open operating field and distinct anatomical dissection were the essential surgical condition of retroperitoneal tumor. Retroperitoneal tumor should be completely resected in principle. The tumor and invaded neighboring organs should be resected at the same time. Complete resection was the key to improving the survival rate for recurrent retroperitoneal tumor.