原发性盆腔腹膜外巨大肿瘤29例的外科治疗

Surgery for 29 cases of extraperitoneal pelvic neoplasms

目的 探讨原发性盆腔腹膜外巨大肿瘤的外科治疗经验,以提高肿瘤切除率及安全性.方法 回顾性分析1995-2013年共29例盆腔巨大肿瘤切除病例的临床资料.术前通过CT、MRI及医学三维重建（3D）技术对肿瘤的可切除性及手术难易程度进行评估,术前5例介入血管栓塞,术中2例行一侧髂内动脉结扎,2例术中临时阻断腹主动脉.术中联合多种手术入路切除肿瘤.结果 29例患者中,11例行肿瘤切除,5例行肿瘤切除＋直肠切除＋乙状结构造瘘,4例行肿瘤切除＋直肠破损修补＋乙状结肠临时造瘘,3例行肿瘤切除＋膀胱部分切除,4例行肿瘤切除＋子宫卵巢切除,2例行肿瘤＋尾骶骨切除.25例患者手术后恢复顺利,出现并发症4例,分别为肠梗阻2例,盆腔脓肿1例,下肢静脉血栓1例,经保守及介入治疗痊愈.无手术死亡,并发症发病率为13.8％（4/29）.结论 盆腔巨大肿瘤术前影像学评估,联合切口及联合脏器切除,分次切除及复发后再切除是其有效检查和治疗手段.

Objective To investigate the experience of surgical treatment of primary extraperitoneal pelvic neoplasms,in order to improve tumor resection rate and safety.Methods The clinical data of 29 cases of primary extraperitoneal pelvic neoplasms were retrospectively analyzed from 1995 to 2013.To evaluate tumor resection preoperatively by CT,MRI and three dimensional reconstruction （3 d） medical technology,5 cases of preoperative interventional vascular embolization,intraoperative 2 cases in the iliac artery ligation,2 cases of intraoperative temporary blocking abdominal aorta.Intraoperative combined a variety of surgical approach to remove the tumor.Results Twenty-nine cases of patients,11 underwent tumor resection,5 underwent tumor resection and rectum resection plus sigmoid colostomy,the structure of 4 underwent tumor resection and repair damaged ＋ sigmoid colon rectum temporary colostomy,3 underwent tumor resection and bladder partial nephrectomy,4 underwent tumor resection and uterine ovarian resection,2 underwent tumor resection ＋ tail sacral tumor resection.25 patients recover well after the surgery,complications of 4 cases：intestinal obstruction in 2 cases respectively,pelvic abscess in 1 case,lower limb venous thrombosis in 1 case,cured by conservative and interventional therapy.No operative mortality and incidence of complications was 13.8% （4/29）.Conclusion Pelvic tumor preoperative imaging evaluation,combined incision and multi-visceral resection,fractional resection and recurrence after resection is the effective examination and treatment.