累及大血管的腹膜后肿瘤处理策略探讨

Strategies for the management of retroperitoneal tumors involving large blood vessels

腹膜后肿瘤(retroperitoneal tumor,RPT)发病较为隐匿,出现症状时肿瘤往往体积较大,多侵犯周围组织与脏器,尤其是腹腔重要血管,是RPT手术主要难点。累及大血管RPT的处理常被很多外科医生视为禁区,但手术仍是目前治疗该病唯一有效的方法,累及大血管RPT的处理决策是提高肿瘤手术切除率的关键。因此,术前对肿瘤累及血管程度的评估,术中对血管重建技术的应用对于肿瘤完整切除至关重要。术前应用影像学检查了解RPT与腹腔大血管之间的关系、浸润情况,手术中良好的术野为处理和控制血管出血创造了有利条件;累及大血管RPT在完整切除时,需要对一些重要的血管进行修复与重建,自体血管的使用技术已日益成熟,人工血管和补片的应用也为手术创造了条件。术前评估、手术策略、术后管理对肿瘤外科医生在累及大血管RPT的患者治疗过程中起着至关重要的作用。

The onset of retroperitoneal tumors(RPT)is relatively insidious and,by the time symptoms appear,tumors tend to be relatively large,having already invaded the surrounding tissues and organs.Retroperitoneal tumor invasion of the key large blood vessels in the abdominal cavity increases the complexity of surgery and makes surgeons reluctant to attempt resection.However,surgery is still the only effective method for treating retroperitoneal tumors at present.Preoperative assessment of the extent of tumor involvement with the blood vessels and the ability to apply revascularization techniques intraoperatively are important not only to take an informed decision regarding the operation but also to achieve complete retroperitoneal tumor resection and to improve the rate of resection.Preoperative imaging is often used before surgery to understand the relationship between retroperitoneal tumors and the great abdominal vessels and to determine the degree of infiltration.Prior knowledge of the surgical field is favorable for the treatment and control of vascular bleeding.For the repair and reconstruction of principal blood vessels,autologous blood vessel technology has become established,and techniques that utilize artificial blood vessels and mesh are being adopted.Preoperative evaluation,surgical strategy,and postoperative management are all important components in the successful treatment of patients with retroperitoneal tumors involving large vessels.