腹直肌旁入路在盆腔腹膜外软组织肿瘤手术中的应用

Application of pararectus approach in pelvic extraperitoneal soft tissue tumor surgery

目的探讨腹直肌旁入路在盆腔腹膜外软组织肿瘤手术中应用的效果。方法 2012年1月~2017年1月间收治的应用腹直肌旁入路治疗的盆腔腹膜外软组织肿瘤病人19例。单一腹直肌旁入路5例,腹直肌旁入路+延长入路8例,腹直肌旁入路联合后方K-L入路6例。结果 19例盆腔腹膜外软组织肿瘤均完整切除,切口长度9~23 cm,手术时间90~210分钟,出血量420~1240 ml,无神经、盆腔脏器损伤及下肢深静脉血栓等并发症。2例术中出现股静脉损伤且术中及时修补,术后1周和术前VAS评分分别为3.4±0.8和7.3±1.6。19例均得到随访,随访时间8~58个月,平均(26.0±5.8)个月,无复发14例,局部肿瘤复发并再次行手术切除2例,恶性肿瘤因远处转移死亡3例。结论腹直肌旁入路可快速进入盆腔腹膜后位置,相比于骨盆其他手术入路,可触及解剖结构更为广泛,适用于盆腔腹膜后软组织肿瘤切除手术。

Objective To investigate the effect of pararectus approach in the operation of pelvic extraperitoneal soft tissue tumors.Methods A retrospective analysis of pelvic peritoneum in our hospital from January 2012 to January 2017, the application of lateral rectus approach in the 19 patients’ treatment of soft tissue tumors.Single rectus approach was performed in 5 cases, pararectus approach+extended approach in 8 cases,pararectus approach combined with posterior K-L approach in 6 cases.Results 19 cases of pelvic retroperitoneal soft tissue tumors were completely resected,incision length 9~23 cm,operation time 90~210 min,bleeding 420~1240 ml,there were no nerve injury,pelvic organ injury,deep vein thrombosis or other complications,2 cases had femoral vein injury and intraoperative timely repair,postoperative VAS score(3.4±0.8)was significantly lower than the preoperative VAS score(7.3±1.6).19 patients were followed up,the follow-up time was 8~58 months[(26.0±5.8)months],14 patients without recurrence,2 cases of local tumor recurrence,and again underwent surgical resection,3 cases of malignant tumor patients with distant metastasis and death.Conclusion The pararectus approach can quickly enter the pelvic retroperitoneal space.Compared with other surgical approaches of the pelvis,the palpable anatomical structure is more extensive,and it is suitable for the resection of pelvic retroperitoneal soft tissue tumors.