5例下腔静脉平滑肌肉瘤的外科治疗分析

目的探讨下腔静脉平滑肌肉瘤的外科处理方法及临床疗效。方法回顾性分析5例患者临床资料,结合既往腹膜后肿瘤的手术经验,综合文献资料,分析下腔静脉平滑肌肉瘤的治疗要点。结果肿瘤来源于下腔静脉中段的3例,上段和下段各1例。4例按术前计划切除了肿瘤,其中2例达RO切除,分别随访20个月和22个月无复发,1例R1切除术后6个月复发而再次手术,后随访24个月未复发,1例有肝转移行R2切除,术后存活8个月,1例在术中发现肿瘤延及右心房且浸润血管而仅行活检,术后生存仅2个月。3例下腔静脉切除以后未重建,术后无肾功能衰竭等严重并发症。结论术前CT/MRI联合检查,主要进行肿瘤定位,评估手术切除的可能性;造影检查可以明确下腔静脉的走行、通畅程度以及侧支循环情况,可减少术中盲目探查引起的静脉性失血,同时指导下腔静脉切除以后是否需要重建;RO根治性切除是减少复发、延长生存时间的主要手段;术后有短暂的肾功能不全者可以通过血滤很快恢复;术后局部复发的患者可以再次手术,可明显延长生存时间。

Surgical operation of 5 cases of leiomyosarcoma of the inferior vena cava

Objective To investigate the surgical operation method and its clinical efficacy for leiomyosarcoma of the inferior vena cava. Method The clinical data of 5 tumor patients were reviewed retrospectively, and historical surgical ex- periences of retroperitoneal tumor and comprehensive literature were combined to seek the curative measures of leiomyosar- coma of the inferior vena cava. Result Of the 5 cases, 3 cases of leiomyosarcoma originated from the middle of the inferi- or vena cava, and 1 case each in upper and lower segments. 4 cases had undergone surgical resection as planned, in which 2 cases achieved R0 resection, and were recurrence-free in more than 20 months of follow up; And 1 cases reached R1 re- section, but developed postoperative recurrence and received reoperation after 6 months, with no recurrence during 24-month follow up; 1 patient had liver metastases thus received R2 resection, gaining 8-month survival; 1 case was found during operation that the tumor had extended to right atrium and blood vessels were infiltrated, and only got biopsy per- formed, obtaining just 2-month survival. No IVC reconstruction were undergone in 3 cases of inferior vena cava resection, and no serious complication occurred, e. g. , renal failure. Conclusion Preoperative CT/MRI examination is applied primarily on locating tumor and assessing the possibility of surgical resection, while angiography identifies the path, blood flow and collateral circulation of inferior vena cava, thus helps to reduce blood loss in probing surgery and assists in deci- sion making of IVC reconstruction ; R0 radical resection is the major factor in reducing recurrence and prolonging survival ; patients who developed postoperative transient renal insufficiency may recover rapidly via blood filtration; and reoperation may prolong survival time for patients with postoperative local recurrence.