巨大腹膜后肿物切除联合胰十二指肠切除10例诊治分析

Pancreaticduodenectomy for large retroperitoneal tumor resection:An analysis of 10 cases

目的探讨巨大腹膜后肿物切除时联合胰十二脂肠切除是否显著增加手术风险。方法回顾性分析2015年9月至2016年10月北京大学肿瘤医院软组织与腹膜后肿瘤中心行巨大腹膜后肿物切除联合胰十二指肠切除10例病人临床资料,总结其手术相关并发症及围手术期效果。结果 10例病人均顺利切除肿瘤。手术时长为360~1020 min,术中出血量400~6000 mL,10例病人除联合胰十二指肠切除外,均联合了结肠的部分切除,6例联合了血管的切除和替代,5例联合右肾及右肾上腺的切除,5例行右侧膈肌的部分切除及修补,4例联合肝脏的切除。术后发生B级以上胰瘘2例,Clavien-DindoⅢa级以上并发症2例,无围手术期死亡病例。结论腹膜后巨大肿物切除联合胰十二指肠切除术并不显著增加手术风险,安全可行。

Objective To investigate the feasibilities and safeties of pancreaticduodenectomy for the surgical treatment of large retroperitoneal tumors. Methods The clinical data of 10 consecutive cases of large retroperitoneal tumors performed pancreaticduodenectomy at Soft Tissue and Retroperitoneal Tumor Center of Peking University Cancer Hospital between September 2015 and October 2016 were analyzed retrospectively. Surgical complication and perioperative outcome were summarized. Results All tumors were resected completely. Operations lasted for 360 to 1020 min. The blood loss was 400 to 6000mL. Pancreaticduodenectomy and partial colectomy were performed in all 10 patients, combined with 6 cases of large vessels resection and replacement, 5 cases of right nephrectomy and adrenalectomy,5 cases of diaphragm partial resection and repair,4 cases of hepatectomy. Two cases were observed with ISGPF Grade B pancreatic fistula and 2 cases with complication of Clavien-Dindo Ⅲa and V, respectively. No patient died of complications during perioperative period. Conclusion Pancreaticduodenectomy is safe and feasible in resection of large retroperitoneal tumors.