经腹腔入路腹腔镜腹膜后肿瘤切除术的临床疗效

Clinical efficacy of laparoscopic resection for retroperitoneal tumor via transabdominal approach

目的：探讨经腹腔入路腹腔镜腹膜后肿瘤切除术的临床疗效。方法：采用回顾性横断面研究方法。收集2011年1月至2017年8月福建医科大学附属协和医院收治的37例行经腹腔入路腹腔镜腹膜后肿瘤切除术患者的临床病理资料。左季肋区腹膜后肿瘤切除术入路借鉴腹腔镜胰体尾切除术，左髂区腹膜后肿瘤切除术入路借鉴腹腔镜左半结肠手术，右季肋区腹膜后肿瘤切除术入路可借鉴腹腔镜胰十二指肠切除术，右髂区腹膜后肿瘤切除术入路借鉴腹腔镜右半结肠手术。观察指标：（1）术中和术后恢复情况。（2）随访和生存情况。采用门诊和电话方式进行随访，了解患者术后肿瘤复发、转移和生存情况。随访时间截至2017年11月。正态分布的计量资料以±s表示，偏态分布的计量资料以M（范围）表示。结果：（1）术中和术后恢复情况：37例患者均顺利完成经腹腔入路腹腔镜腹膜后肿瘤切除术。其中4例患者中转开腹手术，4例取辅助小切口完成手术，4例联合行周围脏器切除术，其余25例患者行完全腹腔镜单纯腹膜后肿瘤切除术。37例患者手术时间为（181±73）min，术中出血量为（160±87）mL，术后胃肠功能恢复时间为（3.0±1.0）d，术后引流管拔除时间为（3.0±2.0）d。术后共3例患者发生并发症，包括乳糜漏 2例，胃排空障碍1例，均经对症处理后好转；无围术期死亡患者。37例患者术后住院时间为（7±4）d。（2）随访和生存情况：37例患者均获得术后随访，随访时间为3～82个月，中位随访时间为30个月。随访期间，1例炎性肌纤维母细胞瘤患者于术后15个月复发，再次行手术切除，二次手术后9个月出现肝转移，多次行介入手术治疗；1例Castleman病患者和5例淋巴瘤患者术后定期行化疗，无瘤生存；其余患者无瘤生存。结论：经腹腔入路腹腔镜腹膜后肿瘤切除术安全可行。

Objective：To investigate the clinical efficacy of laparoscopic resection for retroperitoneal tumor via transabdominal approach. Methods：The retrospective cross-sectional study was conducted. The clinicopathological data of 37 patients with retroperitoneal tumor who underwent laparoscopic resection via transabdominal approach at Fujian Medical University Union Hospital between January 2011 and August 2017 were collected. The surgical approach of resection for retroperitoneal tumor at the left hypochondriac region, left iliac region, right hypochondriac region and right iliac region referred to laparoscopic distal pancreatectomy, laparoscopic left hemicolectomy, laparoscopic pancreatoduodenectomy and laparoscopic right hemicolectomy respectively. Observation indicators： （1） intra and post-operative recovery situations; （2） followup and survival situations. Followup using outpatient examination and telephone interview was performed to detect post-operative tumor recurrence, metastasis and survival of patients up to November 2017. Measurement data with normal distribution were represented as ±s. Measurement data with skewed distribution were described as M （range）. Results：（1） Intra and post-operative recovery situations： 37 patients underwent successfully laparoscopic resection for retroperitoneal tumor via transabdominal approach. Among 37 patients, 4 were converted to open surgery, 4 were completed surgery with assisted small incision, 4 were combined with adjacent organ resection and other 25 underwent totally laparoscopic resection for retroperitoneal tumor. The operation time, volume of intraoperative blood loss, post-operative gastrointestinal recovery time, post-operative drainagetube removal time and duration of post-operative hospital stay were respectively （181±73）minutes, （160±87）mL, （3.0±1.0）days, （3.0±2.0）days and （7± 4）days. Of 37 patients, 3 with post-operative complications including 2 of chylous fistula and 1 of delayed gastric emptying were improved by symptomatic treatment. There was no perioperative death. （2） Followup and survival situations： 37 patients were followed up for 3-82 months, with a median time of 30 months. During the followup, 1 patient with inflammatory myofibroblastic tumor had recurrence at 15 months post-operatively and underwent surgical resection, however, the patient had liver metastasis at 9 months after the second operation and underwent interventional therapy repeatly. One patient with Castleman and 5 with lymphoma underwent regular chemotherapy and achieved disease-free survival. The other patients had disease-free survival. Conclusion：Laparoscopic resection for retroperitoneal tumor via transabdominal approach is safe and feasible.