腹膜后肉瘤联合大段髂外动脉切除后与髂内动脉吻合重建可行性分析

Feasibility analysis of long external iliac artery resection and reconstruction without graft in retroperitoneal sarcoma

目的探讨腹膜后肉瘤联合大段髂外动脉切除后与同侧或对侧髂内动脉进行吻合的可行性与安全性。方法回顾性分析2017年1月至2019年9月北京大学肿瘤医院软组织与腹膜后肿瘤中心收治的5例腹膜后肉瘤联合大段(5~8 cm)髂外动脉切除病例的临床资料,均未使用人工血管,而采用与同侧或对侧髂内动脉进行吻合重建。结果5例病人均完整切除肿瘤,手术时间为380~540 min,术中出血600~4000 mL。术后病理学检查示,平滑肌肉瘤2例,去分化脂肪肉瘤1例,多形性脂肪肉瘤1例,多形性未分化肉瘤1例。肿瘤最大径为15~23 cm,均为R0切除。无腹腔感染、腹腔出血、消化道或泌尿道瘘等术后并发症。术后1周增强CT检查示动脉吻合通畅,术后住院时间为10~20 d,无围手术期死亡。随访33(12~45)个月,重建动脉均保持通畅,无复发和死亡病例。结论腹膜后肉瘤联合大段髂外动脉切除后可选择与同侧或对侧髂内动脉进行吻合重建,安全可行。

ObjectiveTo explore the safety and feasibility of long external iliac artery resection and anastomose to the internal iliac artery translocation without graft in the operation of retroperitoneal sarcoma.MethodsThe clinical data of5 cases of long external iliac artery resection and anastomose to the internal iliac artery translocation without graft in the operation of retroperitoneal sarcoma admitted from January 2017 to September 2019 in Sarcoma Center,Peking University Cancer Hospital were analyzed retrospectively.Results Complete resection(R0)were successfully performed in all patients.The operation time and blood loss was 380 to 540 min and 600 to 4000 mL respectively.Pathological findings were suggestive of 2 leiomyosarcoma,1 dedifferentiated liposarcoma,1 pleomorphic liposarcoma and 1 undifferentiated pleomorphic sarcoma,with the maximum tumor diameter of 15 to 23 cm.The length of hospital stay was 10 to 20 days.And at POD7,a CT scan showed that the patency of the all reconstructed arteries were good.No complication of abdominal infection,bleeding,GI or urinary tract fistula or perioperative death was observed.After a median follow-up of 33 months,no artery associated complications occurred,and no recurrence or death occurred.ConclusionLong external iliac artery resection and anastomose to the internal iliac artery translocation without graft in the operation of retroperitoneal sarcoma is safe and feasible.