腹膜后肿瘤累及下腔静脉和髂静脉的外科处理(附12例报告)

目的：探讨腹膜后肿瘤侵及下腔静脉或髂静脉时的手术方法。方法：总结1990--2001年12例累及下腔静脉或髂静脉的腹膜后肿瘤手术切除及血管重建方面的经验。结果：对12例患者成功实施了腹膜后肿瘤(包括受累血管)完整切除和相应的重大血管重建，无手术死亡病例。结论：侵及下腔静脉或髂静脉的腹膜后肿瘤应尽可能将肿瘤及受累血管完整切除，必要时行血管重建，可以减少术后局部复发及延长生存时间。     

腹膜后肿瘤切除联合重要血管重建12例

背景与目的:腹膜后肿瘤的治疗,手术切除仍是惟一可能根治的有效方法.但临床确诊时,多数肿瘤发现较晚,常累及腹腔内重要血管,即属手术相对禁忌症.本研究旨在探讨累及腹腔内重要血管的腹膜后肿瘤切除的处理方法,以提高切除率及生存率.方法:回顾性分析了2003年1月-2007年6月我院外科手术治疗的12例腹膜后肿瘤累及腹腔内重要血管的患者,经手术切除并行人工血管重建术.结果:成功完成了12例腹膜后肿瘤及受累血管的完整切除和相应的重要血管重建术,术后无1例围手术期死亡.结论:累及腹腔内重要血管的腹膜后肿瘤不是根治性切除的手术禁忌症,联合重要血管切除并行血管重建手术是安全的,并可明显提高切除率,降低复发率,延长患者存活时间.     

肢体软组织肉瘤及受累大血管切除联合人工血管重建的临床研究

目的探讨肢体软组织肉瘤及受累的大血管切除联合人工血管重建的临床疗效。方法对19例累及肢体重要血管的软组织肉瘤患者行肿瘤屏障切除联合人工血管手术,8例同时重建动脉和静脉,4例重建动脉,7例重建静脉,均采用人工血管置换。观察术后血管通畅及肿瘤复发情况。结果无1例出现重建血管感染,伤口均一期愈合。全部患者随访3~32个月,平均18个月。随访期间重建动、静脉通畅率分别为100%和46%,未见肿瘤复发。结论肢体软组织肉瘤累及重要血管进行切除联合人工血管重建安全可靠,能提高切除率,降低肿瘤复发率。     

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。     

岛叶低级别胶质瘤的显微外科治疗

目的评价显微外科手术治疗岛叶低级别胶质瘤的临床效果。方法回顾性分析15例经显微外科手术治疗的岛叶低级别胶质瘤的切除程度和术后神经功能缺失情况。结果通过翼点或扩大的翼点显微外科手术入路，全切肿瘤12例，大部切除3例；术后2例患者轻度偏瘫，1例面瘫，余无其它并发症。结论显微外科手术是治疗岛叶低级别胶质瘤的有效手段；合适的显微手术入路和术中周围的血管及脑组织的保护是提高手术疗效的关键。术前采用血管造影检查对手术安全有重要意义。     

复发性腹膜后肉瘤的手术治疗探讨

背景与目的：腹膜后肉瘤是罕见的恶性肿瘤,彻底手术切除是最有效的治疗方法,但是其术后复发率很高。复发性腹膜后肉瘤通常在复查时被发现,治疗方法仍是手术切除,但由于其解剖层次不清,因此手术难度大,出血多。该研究旨在探讨复发性腹膜后肉瘤的诊断及手术方式。方法：回顾性分析2007年10月—2016年10月收治的25例复发性腹膜后肉瘤,根据手术情况分组后使用log-rank检验对完整切除组与部分切除或活检组两者进行单因素预后分析,并使用Kaplan-Meier法计算生存率。结果：全组25例完整切除16例,占64.0%(16/25),部分切除6例,占24.0%(6/25),未切除活检为3例,占12.0%(3/25)。完整切除中联合脏器切除8例,占完整切除的50.0%(8/16)。24例获随访,完整切除和部分切除两者5年生存率为56.3%(9/16)和20.0%(1/5),差异有统计学意义(P<0.05)。结论：手术切除是治疗复发性腹膜后肉瘤最有效的方法,联合脏器切除能提高肿瘤完整切除率。本病术后复发率高,术后需密切随访。     

腹膜后肿瘤32例诊治分析

由于腹膜后肿瘤发生部位的缘故，使完全切除肿瘤有一定难度。作者分析了32例腹膜后肿瘤的诊治情况，认为充分的术前检查，良好的术前准备及仔细的术中分离操作，是提高手术成功率的关键。     

101例原发性腹膜后肿瘤外科治疗

目的探讨原发性腹膜后肿瘤的外科治疗。方法回顾性分析1992年来原发性腹膜后肿瘤手术切除101例，总结提高手术治疗效果的策略。结果其中良性肿瘤38例，恶性肿瘤63例，均经术后病理证实。肿瘤完整切除率71．29％。良性肿瘤的手术完整切除率高于恶性肿瘤，术中失血少，需要合并切除的脏器少，术后复发率相对低。全部病人无一例术中死亡。术后复发33例，再次手术19例。结论手术完整切除是腹膜后肿瘤治疗首选的方法，术前准备非常重要，对复发的肿瘤应该争取再次手术。     

肝脏术中超声的临床价值

目的总结肝脏术中超声的优越性,准确诊断病变,提高原发性肝肿瘤的手术切除率。方法采用高频率５．０ＭＨｚ探头,探头置于肝表面,观察肿物大小、数量、部位与血管的关系。结果４２例原发性肝肿瘤,２９例经术中超声定位后切除肿瘤;４例术中超声发现肿物与大血管关系密切,无法切除;６例术中发现多发病灶。结论术中超声较经腹超声和术中探查敏感,其优越性为：（１）定位准确,能提高手术切除率;（２）可确定肿瘤与血管关系;（３）弥补术前影像检查的不足;（４）术中可进行肝脓肿开窗术及肝囊肿介入治疗。     

复发性和转移性腹膜后脂肪肉瘤的治疗

目的探讨复发性和转移性腹膜后脂肪肉瘤的治疗方法。方法回顾性分析２５例复发性和转移性腹膜后脂肪肉瘤作积极外科治疗，辅以放疗和化疗的临床资料。结果除６例仍在２年内治疗中，余１９例中１８例生存３年以上，１０例生存５年以上，５年生存率为５２．６％。手术的次数和有无合并脏器切除与生存无明显关系。完全切除能得到较好的预后，而部分切除结合放疗和化疗能也得到较满意的效果。手术加放疗是最满意的结合。结论复发性和转移性腹膜后脂肪肉瘤的预后差与完全切除肿瘤及部分切除的肿瘤辅以放疗和化疗有关     

Significance of blood vessel leakiness in cancer

Despite major advances in the field of tumor angiogenesis, relatively little attention has been paid to the permeability of blood vessels in tumors. The leakiness of tumor vessels is well documented in experimental tumor models and in human cancer, but the mechanism is poorly understood, as are the implications to the rate of cancer growth, predisposition to metastasis, and delivery of macromolecular therapeutics to tumor cells. Sixteen experts in the fields of cancer biology and vascular biology gathered at the William Guy Forbeck "Focus on the Future" Conference to discuss this topic. The meeting was the first of its kind focused on the significance of blood vessel leakiness in tumors. The participants discussed the cellular basis of tumor vessel leakiness, endothelial barrier function of blood vessels, monitoring tumor vessel leakiness, mediators of endothelial leakiness, consequences of tumor vessel leakiness, genomic analysis of vascular targets, targeting drugs to tumor vessels, and therapeutic manipulation of tumor vessels. The group concluded that a more complete understanding of the basic biology of tumor vessels will be necessary to fully appreciate the consequences of vessel leakiness in cancer. New research tools such as intravital measurements of tumor blood flow and vessel leakiness, in vivo phage display, magnetic resonance imaging, and use of selective angiogenesis inhibitors will contribute to this understanding.     

MRI assessment of hemodynamic effects of angiopoietin-2 overexpression in a brain tumor model

Despite treatment efforts, the median survival in patients with glioblastoma multiforme, the most aggressive form of glioma, does not extend beyond 12–15 months. One of the major pathophysiological characteristics of these tumors is their ability to induce active angiogenesis. Thus, based on the lack of efficient therapies, agents that inhibit angiogenesis are particularly attractive as a therapeutic option. However, it has been recently proposed that although specifically targeting vascular endothelial growth factor, the main angiogenic factor, certainly leads to significant tumor regression, it could also be followed by tumor relapses. In this case, angiogenesis is driven by alternate pathways that include other angiogenic factors. One possible strategy to overcome this therapeutic obstacle is to overexpress antivascular factors such as angiopoietin-2 (Ang2). Here, by using MRI and histological analysis, we studied the vascular events involved in glioma growth impairment induced by Ang2 overexpression. Our results show that an increase in Ang2 expression, during the tumor growth, leads to a significant decrease in tumor growth (~86%) along with an increase in the survival median (~70%) but does not modify the tumor vascular area or cerebral blood volume. However, tumor Ang2-derived blood vessels display an abnormal, enlarged morphology. We show that the presence of Ang2 leads to an enhancement of tumor perfusion and a decrease in tumor vessel permeability. Based on our MR image evaluations of hemodynamic tumor vessel changes, we propose that Ang2-derived tumor vessels lead to an inadequate oxygenation of the tumor tissue, leading to impairment in tumor growth.     

Role of nitric oxide in angiogenesis and microcirculation in tumors

Nitric oxide (NO) is a free radical molecule with high reactivity, a short half life and a variety of physiological activities. The role of NO in tumor microcirculation, based on the data collected to date, can be summarized as follows: 1) NO may partially mediate tumor angiogenesis; 2) endogenous NO derived from tumor vascular endothelium and/or tumor cells increases and/or maintains tumor blood flow via dilatation of arteriolar vessels, decreases leukocyte-endothelial interaction, and increases vascular permeability; 3) exogenous NO can increase tumor blood flow via vessel dilatation, and reduce vessel tone; and 4) NO production rates and vascular response to NO are heterogeneous and tumor-dependent. Modulation of NO level in tumor vessels can alter tumor hemodynamics and thus augment oxygen, drug, gene vector and effector cell delivery to solid tumors.     

Determinants of tumor blood flow: a review

Blood flow rate in a vascular network is proportional to the pressure difference between the arterial and venous sides and inversely proportional to the viscous and geometric resistances. Despite rapid progress in recent years, there is a paucity of quantitative data on these three determinants of blood flow in tumors and several questions remain unanswered. This paper reviews our current knowledge of these three parameters for normal and neoplastic tissues, the methods of their measurements, and the implications of the results in the growth and metastasis formation as well as in the detection and treatment of tumors. Microvascular pressures in the arterial side are nearly equal in tumor and nontumorous vessels. Pressures in venular vessels, which are numerically dominant in tumors, are significantly lower in a tumor than those in a nontumorous tissue. Decreased intravascular pressure and increased interstitial pressure in tumors are partly responsible for the vessel collapse as well as the flow stasis and reversal in tumors. The apparent viscosity (viscous resistance) of blood is governed by the viscosity of plasma and the number, size, and rigidity of blood cells. Plasma viscosity can be increased by adding certain solutes. The concentration of cells can be increased by adding cells to blood or by reducing plasma volume. The rigidity of RBC, which are numerically dominant in blood, can be increased by lowering pH, elevating temperature, increasing extracellular glucose concentration, or making the suspending medium hypo- or hypertonic. Effective size of blood cells can be increased by forming RBC aggregates (also referred to as rouleaux). RBC aggregation can be facilitated by lowering the shear rate (i.e., decreasing velocity gradients) or by adding macromolecules (e.g., fibrinogen, globulins, dextrans). Since cancer cells and WBC are significantly more rigid than RBC, their presence in a vessel may also increase blood viscosity and may even cause transient stasis. Finally, due to the relatively large diameters of tumor microvessels the Fahraeus effect (i.e., reduction in hematocrit in small vessels) and the Fahraeus-Lindqvist effect (i.e., reduction in blood viscosity in small vessels) may be less pronounced in tumors than in normal tissues. Geometric resistance for a network of vessels is a complex function of the vascular morphology, i.e., the number of vessels of various types, their branching pattern, and their length and diameter. Geometric resistance to flow in a single vessel is proportional to the vessel length and inversely proportional to vessel diameter to the fourth power.(ABSTRACT TRUNCATED AT 400 WORDS)     

胰腺癌术中门静脉/肠系膜上静脉重建材料的研究进展

随着外科技术的发展和围术期管理水平的提升,以往认为无法手术的侵犯大血管的腹部肿瘤,在血管重建技术的加持下,使得手术切除肿瘤成为可能。联合血管切除手术的应用使肿瘤切除范围扩大,提高了肿瘤的R0切除率,延长了患者生存期。门静脉（portal vein,PV）/肠系膜上静脉（superior mesenteric vein,SMV）系统,对于包括胰腺癌在内的肝胆胰及十二指肠肿瘤的手术至关重要,是上述肿瘤常累及的主要血管结构。联合PV/SMV系统切除重建技术的安全应用,为这类患者带来了新的希望。PV系统两端均为毛细血管网,血流速度慢,血液黏稠易凝,重建失败将严重影响肝脏血供,甚至引起肝功能衰竭。血管重建材料是影响手术效果和预后的重要因素,目前在静脉修复中,自体静脉、自体其他组织、同种异体静脉与人工材料均可作为供选择的修复材料,选择合适的材料对手术至关重要。本综述阐述了PV/SMV修复重建材料的研究进展,并说明了各种材料的特点与临床应用。      

A new glioma model in rat: The C6 spheroid implantation technique permeability and vascular characterization

The C6 spheroid implantation glioma model is a simple, easily reproduced model for primary gliomas in which C6 astrocytoma cells are grown in vitro as spheroids and subsequently implanted into the brains of Sprague Dawley rat hosts. This report describes the growth, histology, vessel architecture and vascular permeability of the resulting tumors. The appearance of the tumor was investigated by light and electron microscopy, and by using the alkaline phosphatase technique. The leakage of tracer was measured from vessels in the tumor and peritumoral area at various times during tumor development. The spheroid implant produces a fully vascularized, rapidly growing tumor with many of the characteristics of glioblastoma multiforme, from an avascular focus of neoplastic cells. The major advantage of this model is that the tumors grow in a spheroidal fashion and the tumor-brain interface can be easily located. Many of the important events in the process of vascularization take place at the tumor-brain interface. Two distinctive vascular events appear to occur simultaneously: 1) proliferation of blood vessels and their growth into the tumor mass so that they develop into typical, permeable tumor vessels, and 2) migration of tumor cells along normal vessels into the surrounding brain. Tumor vessels were permeable to the tracer Evans Blue (EB) from the earliest days of ingrowth. Leakage of the EB increased as the tumors increased in size, but eventually leakage plateaued as tumors developed necrotic centers. II is well known that the structural and permeability characteristics of vessels associated with the tumor affect tumor growth. This model will be useful for a number of proposed studies including assessment of various clinical therapies on tumor growth and development, and more specifically, quantitative analysis of the vascularization process in tumors.     

混合现实技术在腹膜后神经鞘瘤手术中的应用价值

目的:探讨混合现实技术在腹膜后神经鞘瘤手术治疗中的临床疗效与应用价值。方法:回顾性分析2021年1月至2022年4月于我院收治的19例腹膜后神经鞘瘤患者的临床资料，其中男5例，女14例，年龄（42.4±13.2）（20～72）岁，肿瘤最大径为（6.65±2.82）（3.1～11.7）cm。所有患者术前均行肿瘤部位增强三维重建CT扫描，通过混合现实技术对肿瘤的大小、周围解剖关系进行分析，并统计手术失血量及手术时长。同时对手术后的病例进行随访观察。结果:19例患者均行腹膜外入路手术，其中5例患者行经腹直肌外缘切口入路手术，8例行经髂腹股沟切口入路手术，5例行经骶尾部弧形切口入路手术，1例行经腹骶前后联合入路手术。所有患者按照术前方案完整切除肿瘤，肿瘤周围血管神经均保护完好，手术时间（86.3±39.8）（30～182）min，术中失血量（266.8±413.9）（30～1 500）mL。术后3例出现并发症，包括下肢疼痛和排尿异常。全部病例获得随访，随访时间(8.0±3.7)（3～14）个月，随访期内病例未见复发。结论:手术切除是腹膜后神经鞘瘤的首选治疗方式，术前应选择合适手术入路。混合现实技术可用于腹膜后神经鞘瘤的诊疗过程，有助于手术的精准操作。     

Functional characterization of the microcirculation in tumors

Summary This review describes some aspects of tumor vessels and the influence of vasoactive agents on tumor blood flow, particularly the characteristic microcirculation of tumors with regard to its selective increase in blood flow. Elevation of blood pressure by infusion of angiotensin II produced a severalfold increase in tumor blood flow. The increase was selective and specific to the tumor vessels as long as the mean arterial blood pressure was kept under 150 mm Hg. Pressure elevation by angiotensin II also selectively increased tumor oxygen tension and influx of lymph flow from the primary transplanted lesion to the lymph node metastatic lesion. Newly devised techniques for analyzing microhemodynamics of tumor vessels showed that the velocity of tumor blood flow, the vascular area in tumor tissue, and the hydrostatic pressure difference between the tumor vessel and extravascular tissue were markedly enhanced. Thus, the extravasation of material into tumor tissues can be increased by the enhancement of blood flow. This demonstration allowed the development of a new approach to cancer chemotherapy, in which the delivery to tumor tissue of systemically administered anticancer drugs can be selectively enhanced.     

Angiopoietin-1 and -2 exert antagonistic functions in tumor angiogenesis, yet both induce lymphangiogenesis

Members of the Angiopoietin family regulate various aspects of physiologic and pathologic angiogenesis. Although Angiopoietin-1 (Ang-1) decreases endothelial cell permeability and increases vascular stabilization via recruitment of pericytes and smooth muscle cells to growing blood vessels, Angiopoietin-2 (Ang-2) mediates angiogenic sprouting and vascular regression. In this study, we used the Rip1Tag2 transgenic mouse model of pancreatic β-cell carcinogenesis to investigate the roles of Ang-1 and Ang-2 in tumor angiogenesis and tumor progression. On their own, transgenic expression of human Ang-1 or Ang-2 in pancreatic β cells caused formation of peri-insular lymphatic vessels in the absence of effects on blood vessel density, islet morphology, or physiology. When crossed to Rip1Tag2 mice, both Ang-1-and Ang-2-expressing β-cell tumors showed increased peritumoral lymphangiogenesis in the absence of metastasis to local lymph nodes or distant organs. There was no alteration in tumor outgrowth, blood vessel density, or vessel maturation in Ang-1-expressing tumors. In contrast, Ang-2-expressing tumors exhibited diminished pericyte recruitment to blood vessels that were dilated, nonfunctional, and highly permeable. These tumors were hemorrhagic, highly infiltrated by leukocytes, and impaired in outgrowth. Together, our findings establish that Ang-2 antagonizes Ang-1 function, leading to excessive vessel sprouting with impaired pericyte recruitment and vessel stabilization. The poor perfusion of immature blood vessels results in retarded tumor growth, defining an important pathophysiologic pathway required for efficient tumorigenesis.     

Tissue examination to monitor antiangiogenic therapy: a phase I clinical trial with endostatin.

PURPOSE: The purpose of this study was to determine the effect of the angiogenesis inhibitor endostatin on blood vessels in tumors and wound sites. EXPERIMENTAL DESIGN: In a Phase I dose escalation study, cancer patients were treated with daily infusions of human recombinant endostatin. Tumor biopsies were obtained prior to and 8 weeks after initiation of treatment. Blood vessel formation in nonneoplastic tissue was evaluated by creating a skin wound site on the arm with a punch biopsy device. The wound site was sampled with a second biopsy after a 7-day interval. This sequential biopsy procedure was performed prior to and 3 weeks after initiation of endostatin treatment. Vascular density, endothelial cell kinetics, and blood vessel maturity were determined in tumor and skin wound samples. The ultrastructure of tumor blood vessels was examined by electron microscopy. RESULTS: As expected, the tumors were of variable vascular density. Skin wounding induced a vascular granulation tissue containing a high percentage of proliferating endothelial cells. The proportion of immature blood vessels was high in tumors and in wound sites and low in normal skin. No statistically significant difference was detected between pretreatment and treatment samples of tumors and of skin wounds for any of the parameters tested. CONCLUSIONS: Endostatin treatment was not associated with any recognizable vascular changes in tumor samples and did not perturb wound healing at the doses and the treatment schedule used.