原发性腹膜后及肠系膜脂肪肉瘤的诊断及外科治疗

Diagnosis and surgical treatment of primary retroperitoneal and mesentery liposarcoma

目的 探讨原发性腹膜后及肠系膜脂肪肉瘤的外科治疗方法。方法 回顾性分析 1993～ 2 0 0 1年收治的 18例原发性腹膜后及肠系膜脂肪肉瘤病人经手术治疗 2 7例次的临床资料。结果 脂肪肉瘤占同期经手术探查的原发性腹膜后及肠系膜实体瘤的 31 6 % (18/ 5 7) ;临床表现主要为进行性增大的腹部包块与消化道症状 ;病理类型以高分化型多见 (13/ 18) ;首诊后 16例获得临床根治性切除 ,6例复发性脂肪肉瘤病人 ,共接受 15次手术 ;全组合并单侧肾切除 6例 ,部分结肠切除 4例 ,部分空肠切除和胃大部切除各 1例 ;肠系膜脂肪肉瘤手术多采用完整切除术 (8/ 10 )。结论 手术切除是目前唯一有效的治疗方法 ,必要时可行联合脏器切除术 ,但不应强求根治 ;为改善生存质量、延长生存期 ,对多发肿瘤不能完整切除者应积极实施姑息性减瘤术 ,多次复发者有条件可多次手术 ;采用完整切除术、尽量避免肠切除治疗对多发性及复发性肠系膜脂肪肉瘤具有重要临床价值。

Objective To explore the appropriate surgical strategy for the treatment of primary retroperitoneal and mesentery liposarcoma (PRML).Methods The clinical data of 27 operations of 18 cases of PRML were retrospectively analyzed.Results Progressively enlarged abdominal mass and nonspecific digestive symptoms were of chief complaints,and the pathological types were mostly highly-differentiated(13/18).16 cases received clinically curative resection and 6 cases with recurrences underwent 2～3 successive operations respectively.Simultaneous nephrectomy was applied in 6 cases,partial resection of colon in 4 cases.Intac decollement was principally applied in mesentery liposarcomas.Conclusion Timely diagnosis and adequate preoperative evaluation are important.Surgical resection is the most effective choice of treatment,and simultaneously resection of contiguous organs is necessary for certain cases.But palliative surgical treatment should be considered as an active and preferable way in treating cases with multiple or recurrent PRML.Intac decollement is a valuable procedure for multiple or recurrent mesentery liposarcomas.