肝动脉化疗栓塞对原发性肝癌患者术后生存及肿瘤复发的影响

目的探讨原发性肝癌患者手术后肝动脉化疗栓塞（TACE）对肿瘤复发率及患者术后生存率的影响，为原发性肝癌的临床综合治疗提供指导。方法原发性肝癌患者手术后行TACE治疗22例（手术＋TACE组）、仅行手术切除而不行TACE治疗患者20例（单纯手术组），对两组患者术后肿瘤复发率及患者生存率进行比较。结果手术＋TACE组与单纯手术组比较，前者肿瘤1年复发率显著低于后者（P〈0．05），但两组2年复发率差异无显著性（P〉0．05）。手术＋TACE组1年及2年生存率（76．1％，48．2％）均明显高于单纯手术组（52．8％，23．6％）（P〈0．05）。结论原发性肝癌手术后结合TACE治疗，可明显降低肿瘤近期复发率且显著提高患者生存率。     

84例原发性腹膜后肉瘤患者外科处理分析

目的　探讨原发性腹膜后肉瘤的临床处理 ,分析影响其预后因素。方法　收集 84例原发性腹膜后肉瘤患者的临床资料 ,回顾性分析其预后情况。用Kaplan -Meier法估计生存曲线 ,对可能影响患者长期存活的临床 ,病理 ,治疗方法各因素行单因素分析。结果　分级对 5年生存率有显著性影响 (P <0 .0 1)。完全切除率为 5 9.6%,完全切除后 5年生存率和 5年无瘤生存率分别是 48.1%和 3 8.8%,部分切除或活检患者 5年生存率和 5年无瘤生存率均为 0 ,两者存在高度显著性差异 (P <0 .0 0 1)。结论　肿瘤分级和手术切除是否完全是影响腹膜后软组织肉瘤预后的重要因素。对复发病例仍应积极手术治疗。限制肿瘤的假囊不应认为是安全边缘。     

肝动脉栓塞化疗联合微波消融与单纯手术切除对小肝癌疗效比较

目的对比肝动脉栓塞化疗(TACE)联合微波消融(MWA)与单纯手术切除对小肝癌的治疗效果。方法回顾性分析2008年1月至2013年1月共65例小肝癌病人临床资料。65例中30例行肝动脉栓塞化疗联合微波消融,35例单纯手术切除治疗。比较两组肿瘤治疗后的总并发症发生率,术后1、2、3年生存率和复发率等情况。结果肝动脉栓塞化疗联合微波消融组总并发症发生率为10.0%,低于手术组并发症发生率(31.4%),差异有统计学意义(x~2=4.389,P=0.036)。肝动脉栓塞化疗联合微波消融组术后1、2、3年复发率为6.7%、13.3%、23.3%,手术组术后1、2、3年复发率为11.4%、17.1%、31.4%,两组复发率比较差异无统计学意义(x~2=0.465,P=0.495)。肝动脉栓塞化疗联合微波消融组术后1、2、3年总生存率为93.3%、80.0%、60.0%,手术组术后1、2、3年总生存率为91.4%、77.1%、57.1%,两组的生存率比较差异无统计学意义(x~2=0.078,P=0.78)。结论肝动脉栓塞化疗联合微波消融的治疗效果确切,其术后并发症发生率较低,远期疗效与手术切除相近,可考虑作为小肝癌的首选治疗。     

Primary retroperitoneal liposarcoma reoperation of 36 cases

目的 探讨原发性腹膜后脂肪肉瘤再手术的原因、处理策略及手术要点.方法 对2000年6月至2010年6月间36例腹膜后脂肪肉瘤再手术的临床资料进行回顾性分析.结果 原发性腹膜后脂肪肉瘤再手术的主要原因是手术切除不彻底和肿瘤的生物学特性.完全切除与不完全切除5年生存率分别为79.3％和34.5％.再手术后并发症以出血及肠瘘为主.结论 原发性腹膜后脂肪肉瘤再手术既有肿瘤本身原因,也与手术相关.再次手术治疗是治疗该病术后复发病例的积极手段.把握好手术时机、术中彻底切除是再手术成功的关键.     

复发的原发性腹膜后脂肪肉瘤76例临床研究

目的 探讨复发的原发性腹膜后脂肪肉瘤的治疗方法.方法 回顾性分析1999年至2008年收治的76例复发的原发性腹膜后脂肪肉瘤患者临床资料.结果 74例再手术,共行126例次手术,首次复发、再次复发、三次以上复发肿瘤完全切除率分别是62.2%、26.8%、11.4%.肿瘤完全切除组1、3、5年生存率分别是84.5%、71.7%、58.2%(P<0.01),肿瘤部分切除组1、3、5年生存率分别为70.6%、39.3%、21.8%(P<0.01).结论 肿瘤切除不彻底是导致复发的主要原因.复发后再手术是首选治疗,充分做好手术前准备,提高肿瘤完全切除率,争取联合脏器切除达到完全切除是改善预后的关键.对复发的肿瘤应于适当的时机再次手术,并采取恰当的方案.     

高强度聚焦超声治疗原发性肝癌的疗效

目的探讨高强度聚焦超声（HIFU）对原发性肝癌的治疗效果。方法对我科自2005年5月至2006年8月使用高强度聚焦超声治疗的35例原发性肝癌进行回顾性分析。结果本组术后疼痛症状缓解率为69.6%,术后3月生存率94.29%,6月生存率65.59%,1年生存率57.39%;术后生存期较其自然病程延长。结论高强度聚焦超声治疗原发性肝癌可在一定程度上减轻患者症状、改善患者生存质量、延长患者生存时间。     

经阴囊单切口超声刀无结扎双侧睾丸切除术

目的 探讨超声刀睾丸切除术新术式的疗效及安全性。方法 回顾性分析2017年6月至2019年6月于武汉大学中南医院确诊为晚期前列腺癌并行睾丸切除术的69例患者作为研究对象,按照手术方式分为传统手术组和超声刀手术组,传统手术组27例行传统睾丸切除术,超声刀手术组42例行超声刀睾丸切除术,比较两组手术时间、术中出血量、术后住院时间、术后并发症的发生率。结果 超声刀手术组的手术时间和术中出血量均少于传统手术组,差异有统计学意义(P0.05);两组患者的术后住院时间比较差异无统计学意义(P0.05);传统手术组的术后并发症发生率为18.52%,而超声刀手术组术后无并发症发生,差异有统计学意义(P0.05)。结论 超声刀睾丸切除术手术时间短、术中出血少、操作简单、并发症少,有可能成为替代传统睾丸切除术的新术式。     

手术结合术前化疗治疗结肠癌疗效分析

目的探讨术前化疗对结肠癌患者手术及预后的影响。方法回顾性分析本院自2005年1月至2008年10月收治的91例结肠癌患者临床资料,按治疗方案不同分为手术组及综合治疗组。手术组采用标准根治切除术;综合组患者手术前给予XELOX方案化疗后手术治疗。观察两组患者术中肿瘤切除率、淋巴阳性率、术后复发转移率、无病生存期及3年生存率。结果综合治疗组肿瘤完整切除率高于手术组,淋巴结阳性率低于手术组,术后转移率及复发率低于手术组,无病间期长于手术组,术后3年生存率高于手术组,差异有统计学意义,P均<0.05。结论结肠癌患者术前预防性化疗能够改善肿瘤切除率,减少术后肿瘤复发及转移,提高患者生存机率,在结肠癌治疗中起着一定的作用。     

FOLFOX方案同步放疗对局部晚期结直肠癌患者手术疗效及预后的影响

目的探讨FOLFOX同步放疗对T3-T4期结直肠癌手术疗效及预后的影响。方法回顾性收集本院2008年6月至2012年5月收治的T3-T4期结直肠癌患者125例,分为单纯手术治疗组(对照组,61例)以及FOLFOX方案化疗同步放疗后手术治疗组(治疗组,64例)。观察术前FOLFOX方案化疗同步放疗对结直肠癌患者的肿瘤切除率、手术相关并发症、保肛率、3年复发率及生存率的影响。结果对照组和治疗组分别有28例和45例肿瘤完全切除,差异有统计学意义(P0.01)。对照组和治疗组分别有9例和19例切除肿瘤后行保肛手术(P=0.04);两组患者在总生存率和复发率差异均无统计学意义,但在第1、2年的复发率和生存率差异有统计学意义。结论局部晚期结直肠患者术前行FOLFOX方案同步放疗能够提高肿瘤切除率和保肛率,降低近期复发率。     

达芬奇机器人与开腹手术治疗原发性腹膜后肿瘤的对比研究

目的对比达芬奇机器人和开腹手术治疗原发性腹膜后肿瘤的临床疗效。 方法回顾性分析2015年3月至2018年6月在青岛大学附属医院接受手术治疗的57例原发性腹膜后肿瘤患者的临床资料,其中达芬奇机器人手术26例(达芬奇机器人手术组),开腹手术31例(开腹手术组),对比两组的手术时间、术中出血量、术后住院时间、住院费用、并发症情况。 结果达芬奇机器人手术组术中出血量(16.85±16.0)ml,明显少于开腹手术组(55.8±44.2)ml,差异有统计学意义(t＝4.564,P<0.000);达芬奇机器人手术组术后住院时间(3.15±1.7)d,少于开腹手术组术后住院时间(4.61±1.9)d,差异有统计学意义(t＝3.027,P＝0.004);但开腹手术组住院费用(33 825±8 432)元,显著低于达芬奇机器人手术组住院费用(53 712±6 424)元,差异有统计学意义(t＝9.858,P< 0.000);达芬奇机器人手术组的手术时间(156.15±62.9)min、开腹手术的手术时间(144.39±41)min,差异无统计学意义(t＝0.818,P＝0.418);两组并发症发生率分别为0.08%、0.15%,差异无统计学意义(χ²＝0.042,P＝0.837)。 结论虽然住院费用较高,达芬奇机器人治疗原发性腹膜后肿瘤仍有一定优势。     

Retroperitoneal tumors: Review of diagnosis and management

Retroperitoneal tumors are extremely rare tumors occurring in the retroperitoneum. Retroperitoneal tumors are divided into benign tumors and malignant tumors, including retroperitoneal sarcoma. Approximately 70–80% of primary retroperitoneal soft-tissue tumors are malignant; however, these only account for 0.1–0.2% of all malignancies. Retroperitoneal sarcoma is an orphan malignant disease with a low incidence. The information on benign retroperitoneal tumors is limited. The American Joint Committee on Cancer/TNM classification updated to the 8th edition in 2017. In 2010, three new drugs for soft tissue sarcoma were approved based on the results of phase III trials, but the histological subtypes of the patients enrolled in the trials of each drug differed. Recently, in addition to surgery for retroperitoneal sarcoma, the effectiveness of perioperative radiation therapy has become interesting. For malignant retroperitoneal tumors and retroperitoneal sarcoma, survival improvement and locoregional recurrence prevention can be undertaken by carrying out surgery to secure negative margins with wide and combined resection of some adjacent organs, and cooperation with a trained medical team comprising of radiologists, pathologists and medical oncologists in centralized hospitals. Some clinical trials aimed at further improving treatment results by adding preoperative chemotherapy and radiation therapy based on histological confirmation using a correct needle biopsy are in progress. In recent years, molecular profiling has been used to select eligible patients for chemotherapy. In the future, precision medicine with next-generation sequencing technology will be expected among the diverse and potential future treatments for retroperitoneal sarcoma. In this review, we summarized the current state of retroperitoneal tumors and retroperitoneal sarcoma.     

Prognostic factors for first recurrence in patients with retroperitoneal sarcoma

BACKGROUND: Retroperitoneal sarcomas are characterized by a high local recurrence rate despite optimal surgical treatment. The definition of prognostic factors for recurrence could help offer high-risk patients a closer follow-up and a multidisciplinary therapeutic approach. PATIENTS AND METHODS: A cohort of 40 patients treated for a primary retroperitoneal sarcoma was retrospectively analyzed. Median follow-up was 24 months. Patient (sex and age), tumor (maximal size, histologic type, tumor localization, and histologic grade), and treatment (complete vs. incomplete surgery) characteristics were included in univariate and multivariate prognostic factor analyses. RESULTS: After a median follow-up of 24 months (range 3-121), the overall recurrence rate was 65%. Median time between initial surgery and recurrence was 15 months (range 11.5-29.5). In univariate analysis, surgical positive margins (P = 0.011), bilateral tumors (P = 0.0034), nonliposarcoma histologic subtypes (P = 0.043), and a high histologic grade (P = 0.0072) were associated with an increased recurrence rate. All these factors except the histologic subtypes retained an independent prognostic value in the multivariate analysis. Death was strongly related to recurrence (P = 0.0033). CONCLUSION: The optimal treatment of patients with primary retroperitoneal sarcoma should be based on radical surgery, with en bloc organ resection if necessary, to minimize the risk of positive margins. In high-risk patients, close follow-up is mandatory to offer optimal subsequent surgical procedures. The impact of a multidisciplinary therapeutic approach remains to be proved.     

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目的 探讨原发性腹膜后脂肪肉瘤复发、转移机理及预后。方法 复习原发性腹膜后脂肪肉瘤临床资料及文献，总结伴有亚型转化的原发性腹膜后脂肪肉瘤病人的生存时间及复发率。分析反复复发与远外转移的关系。结果 伴有亚型转化的病人平均复发次数高于非亚型转化病人，但生存时间较长。肿瘤复发可诱导去分化危险。结论 亚型转化使腹膜后脂肪肉瘤的复发次数增加而不影响生存期。肿瘤复发诱导去分化危险，肿瘤可获得转移的能力。     

A case of retroperitoneal extraosseous osteogenic sarcoma

A case of primary osteogenic sarcoma in retroperitoneal space is reported. A 33-year-old man was admitted to our hospital with complaints of left flank pain. On examination, a large tumor was found in the left retroperitoneal space. After resection of the tumor, the patient was treated with combined chemotherapy by the regimen of cyclophosphamide, vincristine, adriamycin and dimethyl triazeno-imidazole carboxamide (CYVADIC). He has been well for more than ten months without recurrence. Extraosseous osteogenic sarcoma of the soft tissue is extremely rare, and only 7 cases have been reported in Japan. In general, the prognosis of patients has been very poor with surgery, radiotherapy or chemotherapy alone. A suitable combination chemotherapy or radiotherapy or both following radical surgery should be performed for prolonging survival, and even obtaining a possible cure.     

Limitations of surgery in the treatment of retroperitoneal sarcoma

A retrospective analysis was undertaken of 120 patients with retroperitoneal sarcoma referred to the Royal Marsden Hospital over a period of 20 years. The actuarial 5-year survival rate of all cases following referral was 29 per cent. On univariate and multivariate analysis the principal factors associated with an unfavourable prognosis were the presence of metastases, poor performance status at presentation, high tumour grade and incomplete excision of the primary tumour. The single most important factor affecting the ability to remove the primary tumour completely was multiple organ involvement. After apparently complete excision, however, the probability of local recurrence by 5 years was 85 per cent (95 per cent confidence interval 56-99). The prognosis of patients with retroperitoneal sarcoma is poor.     

原发性腹膜后肿瘤误诊原因分析

目的分析原发性腹膜后肿瘤误诊原因,以提高其诊断率。方法回顾性分析2002年至2010年原发性腹膜后肿瘤误诊病例资料。结果资料完整共175例手术或病理确诊患者,误诊72例,误诊率为41.1%。原发性腹膜后神经鞘瘤、脂肪肉瘤常见且易误诊,误诊疾病为腹盆腔肿块、肾上腺、肾及输尿管肿瘤等。结论腹膜后肿瘤临床症状多不典型,加强对其认识、对相关临床症状的进一步分析以及必要的辅助检查可提高腹膜后肿瘤诊断成功率。     

Tumors at the aortoiliac/inferior vena cava bifurcation: preoperative, anesthetic, and intraoperative considerations

Primary and recurrent retroperitoneal tumors can involve the aortoiliac vasculature. They are often considered inoperable or incurable because of the locally advanced nature of the disease or the technical aspects involved in safely resecting the lesion. Safe resection of these lesions requires experience and extensive preoperative planning for success. A retrospective database review of 76 patients with retroperitoneal tumors identified tumors involving major vascular structures in the abdomen and pelvis undergoing resection of tumor en bloc with the aortoiliac vasculature. Preoperative planning and intraoperative technical maneuvers are reviewed. Patients were followed until time of this report. Four patients with retroperitoneal tumors involving the aortoiliac vessels underwent surgery: two patients with sarcoma (one primary and one recurrent), one with metastatic renal cell carcinoma, and one with a paraganglioma. All patients had resection of the aorta and vena cava or the iliac artery and vein. Arterial reconstruction (anatomic or extra-anatomic) was performed in all cases. The patient with renal cell carcinoma also required venous reconstruction to support a renal autotransplant. Veno-venous bypass was required in one patient. Local control was achieved in 3 of 4 cases. Surgery for retroperitoneal tumors involving major vascular structures is technically feasible with appropriate planning and technique. Multiple disciplines are required, including general surgical oncology, vascular surgery, and possibly, cardiothoracic surgery.     

原发性腹膜后肿瘤50例诊治体会

目的探讨原发性腹膜后肿瘤的诊断和治疗方法。方法回顾性分析1998年1月～2008年1月我院收治的原发性腹膜后肿瘤50例的临床资料。结果本组1年生存率为88％，3年生存率为62％，5年生存率为38％。结论在腹膜后肿瘤的诊断方法中，腹部B型超声、CT检查是目前诊断腹膜后肿瘤最准确、方便的诊断方法。原发性腹膜后肿瘤的治疗应以手术切除为主要手段，对于复发病例应再次手术切除。     

Retroperitoneal sarcoma: Time for a change in attiude?

Background : Retroperitoneal sarcoma (RPS) is considered a disease with poor prognosis partly because of the difficulty with diagnosis at an early stage. This review assesses the current best practice principles for RPS and finds evidence suggesting a better outlook for appropriately managed cases. Recommendations are made for improving diagnostic certainty before laparotomy and inappropriate transperitoneal biopsy occur. Methods : A critical review of the English language literature was conducted using MEDLINE software and searching the terms ‘retroperitoneal sarcoma’ alone or in combination with ‘prognosis’, ‘surgery’ and ‘adjuvant therapy’. Conclusions : Retroperitoneal sarcoma is a rare disease but when appropriately managed the disease‐free survival can be improved and may even approach that of extremity soft tissue sarcoma. One of the greatest barriers to improving outcome is the misinterpretation of clinical signs and an over‐reliance on ultrasound diagnosis in pelvic presentations, or misinterpretation of clinical signs and/or computer tomography (CT) scans in abdominal masses. Physicians referring patients with a retroperitoneal mass should consider more frequently the less common differential diagnoses of an abdominopelvic mass including retroperitoneal sarcoma. This is especially true in circumstances where there is a circumscribed, predominantly solid tumour, with clinical or radiological signs of vascular or rectal displacement, ureteric obstruction and/or classic renal rotational displacement. The more frequent use of CT scans with intravenous and oral contrast with referral prior to inappropriate transperitoneal biopsy is recommended. In atypical cases where preoperative biopsy is necessary, extraperitoneal routes are preferable. Complete en bloc surgical excision at the first laparotomy is the treatment of choice in RPS. Macroscopic clearance may necessitate resection of adjacent viscera, neurovascular structures or abdominopelvic walls but, if achieved, may lead to long‐term survival depending on individual tumour biology.     

Soft tissue sarcoma should be treated at a tumor center: A comparison of quality of surgery in 375 patients

We analyzed the quality of surgery In a population-based series of 375 patients with primary soft tissue sarcoma of the extremity (n 329) and trunk wall (n 46). The quality was measured as the total number of operations performed for the primary tumor-biopsy, excision, reexcision-and the local recurrence rate. A comparison was made between patients referred to our tumor center before surgery (n 195), after surgery (n 102), and not referred for the primary tumor (n 78). The total number of operations for the primary tumor in patients not referred was 1.4 times higher, and in patients referred after surgery 1.7 times higher than in patients referred before surgery. The local recurrence rate in patients not referred was 2.4 times higher, and in patients referred after surgery 1.3 times higher than in patients referred before surgery.

Our findings show that patients with soft tissue sarcoma should be treated at a tumor center, and that they should be referred before surgery.