盆腔腹膜后肿瘤切除术后髂血管处理方式的选择

Surgical management of iliac vessels after retroperitoneal pelvic tumor resection

目的探讨盆腔腹膜后肿瘤切除术后髂血管处理方式的选择。方法回顾性分析2017年7月至2019年11月海军军医大学附属长海医院泌尿外科收治的17例盆腔腹膜后肿瘤压迫或侵犯髂血管患者的临床资料。分析手术相关情况(手术时间、术中出血量、术中手术相关并发症发生情况)、髂血管处理方式、术后恢复情况(住院时间、术后下肢水肿情况及转归、下肢血液回流功能的恢复情况)、并发症发生情况以及转归。结果所有患者均顺利完成手术,术中无手术相关并发症发生。手术时间120~250 min,平均(170.1±32.9)min;术中出血量400~3500 mL,平均(1276.5±870.7)mL。患者均接受了盆腔腹膜后肿瘤切除术,其中3例患者行髂血管重建术,8例患者实施髂血管切除术,6例患者术中未切除髂血管。17例患者术后住院时间为7~20 d,平均(10.2±3.3)d;在接受髂血管重建的3例患者中,2例术后出现水肿轻度加重的情况,后恢复良好;接受髂血管切除术的患者共8例,其中4例术后出现下肢水肿轻度加重的情况,后逐渐减轻;保留髂血管的患者共6例,术后恢复顺利,无下肢水肿。术后无患者出现下肢深静脉血栓、下肢静脉曲张、浅表血栓性静脉炎、皮肤色素沉着、静脉性溃疡及间歇性跛行;出现下肢疼痛4例,下肢水肿轻微加重6例,其中2例同时出现下肢水肿轻微加重和下肢疼痛两个症状,其他患者术后恢复良好,无其他并发症。结论根据术前患者下肢水肿症状以及术前CT或MRI辅助检查结果,评估肿瘤压迫或者侵犯髂血管的程度后选择适用术式,在达到切除肿瘤目的的同时,可减少或减轻患者的并发症。

Objectives To investigate the options of surgical management of iliac vessels after retroperitoneal pelvic tumor resec?tion.Methods This was a retrospective analysis of 17 patients with compression or invasion of the iliac vessel due to pelvic ret?roperitoneal tumors treated at the Department of Urology,Changhai Hospital,Naval Medical University between July 2017 and No?vember 2019.Operation time,intraoperative blood loss,intraoperative complications,surgical management of iliac vessel,hospital?ization time,postoperative lower limb edema,lower limb circulation,postoperative complications,and outcomes were recorded.Results All surgeries were uneventful without intraoperative complications.Operation time ranged from 120 to 250 min with a mean(SD)of 170.1(32.9)min.Intraoperative blood loss ranged from 400 to 3500 mL with a mean(SD)of 1276.5(870.7)mL.All patients underwent retroperitoneal pelvic tumors resection,including three iliac vascular reconstruction,eight iliac vessel exci?sion,and six iliac vessel preservation.The duration of hospitalization ranged from 7 to 20 days with a mean(SD)of 10.2(3.3)days.Of the three patients with iliac vascular reconstruction,two developed worse lower limb edema with excellent recovery at last.Of the eight patients with iliac vessel excision,4 developed worse lower limb edema,and the symptom gradually subsided.Of the six patients with iliac vessel preservation,no lower limb edema occurred.No patients reported lower limb deep vein thrombosis,varicose veins of the lower limb,superficial thrombophlebitis,skin pigmentation,venous ulcers,and intermittent claudi?cation.Four patients had lower limb pain,and 6 had mild lower limb edema,including 2 with both mild edema and pain.Oth?er patients recovered well after surgery with no other complications.Conclusion Based on the symptoms of lower limb edema and preoperative CT or MRI scan,appropriate surgical management of iliac vessels should chosen after assessing the extent of tumor compression or invasion of the iliac vessels while achieving the purpose of tumor resection and reducing complications.