原发性腹膜后巨大肿瘤切除术中大血管的处理

Surgical management of main blood vessels in patients with huge primary retroperitoneal tumors

目的 通过回顾性地研究近 15年手术切除原发性腹膜后巨大肿瘤的经验 ,总结术中大血管的处理方法和技巧对预后及术后并发症的影响。方法 对近 15年完整切除的 5 6例原发性腹膜后巨大肿瘤术中处理过程进行归纳分析 ,总结肿瘤生长部位对腹腔大血管处理的影响和处理受累大血管的技巧。结果 累及左、中、右和左右腹部的原发性腹膜后巨大肿瘤的切除率分别为 87.5 %、35 .7%、5 2 .2 %和 2 6 .7%。结扎切断脾血管 2 3例次 ,修补大血管 14例次。 4例次为意外紧急处理 ,其余均为预防性程序性处理 ;术后死亡 1例。血管修补组与同期血管壁残瘤组 2 8例比较 ,2年复发率分别为 14.3%和 5 3.6 % ,差异显著 ,P <0 .0 1。结论 对于累及腹腔大血管的原发性腹膜后巨大肿瘤 ,左侧大血管较易处理 ,手术切除率明显高于右侧 ;仔细结扎切断脾血管和预防性地切除受累大血管壁再行修补血管是保证手术安全性、提高腹膜后巨大肿瘤切除率、减少复发率的重要操作步骤。

Objective To investigate the effect of surgical management of main blood vessels during operation on the prognosis and complications of the patients with huge primary retroperitoneal tumor. Methods Fifty six cases of huge primary retroperitoneal tumors resected completely in the past 15 years were studied. The effect of tumor local site on the surgical management of big blood vessels and the skills treating the involved big blood vessels were summarized. Results The complete resection rate of huge peritoneal tumors located at left, middle, right and left right abdomen was 87.5% , 35.7% , 52.2% and 26.7% respectively. Ligation of splenic vessels and neoplasty were performed on 23 cases and 14 cases respectively. 2 year recurrent rate in neoplasty group was 14.3% and 53.6% in the tumor residual group at the same period ( P < 0.01 ). Conclusions For huge primary retroperitoneal tumor invading abdominal big vessels, the left big vessels were easily operated on and its complete resection rate was obviously higher than at the right. Careful ligation of splenic vessels and preventive resection and neoplasty of invaded wall of big blood vessels were the important measures for safe operation, increasing complete resection rate and decreasing recurrent rate.