体外循环技术在腹部软组织肿瘤手术中的应用

Role of Cardiopulmonary Bypass Technique in Treatment of Abdominal Soft Tissue Tumor Invading Vena Cava System

目的探讨体外循环技术在腹部软组织肿瘤手术中的应用价值。方法回顾性分析2011年4月至2015年12月期间于复旦大学附属中山医院接受体外循环技术辅助下的腹部软组织肿瘤切除的9例患者的临床资料。结果 9例患者均完整切除肿瘤,无围手术期死亡。6例行全体外循环,3例行部分体外循环。建立体外循环的动脉灌注采用升主动脉途径6例,股动脉途径3例;静脉引流采用下腔静脉途径2例,上腔静脉途径6例,股静脉途径2例,颈静脉途径3例。7例为静脉平滑肌瘤病,1例为小圆细胞恶性肿瘤,1例为平滑肌肉瘤。术后发生十二指肠瘘1例,经保守治疗痊愈;1例发生下腔静脉血栓形成,给予放置下腔静脉滤器处理。9例患者均获随访,随访时间为1-57个月,中位数为4个月。随访期间所有患者均存活,无复发转移病例。结论体外循环技术的应用,为一些复杂的腹部软组织肿瘤病例提供了手术完整切除的可能。

Objective To evaluate the role of cardiopulmonary bypass（CPB） technique in the treatment of the abdominal soft tissue tumor（ASTT）. Methods Clinical data of 9 patients with ASTT who underwent CPB-aided resection in Zhongshan Hospital of Fudan University from April 2011 to December 2015 were analyzed retrospectively. Results All patients were performed complete resection of tumor, without perioperative death. Six patients received complete CPB technique and other 3 patients received partial CPB technique. In establishment of CPB, patterns of arterial perfusion included the ascending aorta（n=6） and femoral artery（n=3）; patterns of venous drainage included the inferior vena cava（n=2）, superior vena cava（n=6）, femoral vein（n=2）, and jugular vein（n=3）. Among of them, 7 patients were diagnosed as intravenous leiomyomatosis, 1 patient was diagnosed as small round cell malignant tumor, and another1 patient was diagnosed as leiomyosarcoma. Two patients occurred postoperative complications, 1 patient was duodenal fistula, with conservative treatment to heal; another 1 patient was inferior vena cava thrombosis, with treatment of placement of the inferior vena cava filter. Nine patients received follow-up, and follow-up time was 1-57 months（the median time was 4-month）, and the survival rate was 100%, no one suffered from recurrence. Conclusion For some patients with complicated ASTT, CPB technique can provide chance to completely resect the tumors.