原发性腹膜后肿瘤46例外科诊疗体会

目的 总结原发性腹膜后肿瘤的临床特征及外科治疗经验.方法 回顾性分析2002年1月至2011年2月我院收治并手术治疗的46例原发性腹膜后肿瘤患者临床资料.结果 本组46例原发性腹膜后肿瘤患者中良性20例,恶性26例.全部切除31例,部分切除8例,联合脏器切除7例.术后随访42例,随访时间4个月至9年.完整切除的良性肿瘤复发率为5.3%,恶性肿瘤复发率为21.0%,5年生存率分别为85.6%、30.3%.完整切除的脂肪肉瘤的复发率57.1%.对于复发的肿瘤行二次手术仍有6例做到了完整切除.结论 术前联合B超、CT、MRI能对原发性腹膜后肿瘤做出较准确的定位诊断,必要时行CTA、DSA、消化道造影、IVP明确肿瘤和大血管、周围脏器的关系.手术应尽可能完整切除肿瘤,联合脏器切除可提高切除率,避免肿瘤组织的残留,减少复发.肿瘤恶性度、切除程度和某些极易复发的组织学类型,如脂肪肉瘤是影响复发的主要因素.术后定期复查,对于复发的肿瘤二次手术仍有可能完整切除,提高患者的生存时间.     

29例复发性腹膜后恶性纤维组织细胞瘤的临床分析

目的总结复发性腹膜后恶性纤维组织细胞瘤的诊治经验。方法回顾性分析1990～ 2 0 0 2年收治的 2 9例复发性腹膜后恶性纤维组织细胞瘤的临床与病理资料。结果 12例(4 1 4 % )患者在首次复发时完整切除肿瘤 ;有 7例患者分别在首次 (2例 )、2次 (3例 )和 3次 (2例 )复发时进行联合脏器切除。对 2 5例患者进行 6个月至 8年的随访 ,1、3年及 5年以上生存率分别为73 2 %、4 6 7%和 19 8%。结论外科手术切除肿瘤是提高复发性腹膜后恶性纤维组织细胞瘤生存率最重要的手段 ,联合脏器切除能提高肿瘤完整切除率。     

63例原发性腹膜后肿瘤的诊断和外科治疗

目的 总结原发性腹膜后肿瘤诊断和外科治疗经验.方法 回顾性分析1990年1月至2007年3月63例经手术治疗且病理证实的原发性腹膜后肿瘤的临床表现、手术治疗、病理类型和随访结果.结果 63例中良性25例,恶性38例.主要临床表现为腹部包块,CT对良恶性判断的约登指数为85%,良性肿瘤完整切除率为88%,恶性肿瘤为68%,联合脏器切除占肿瘤完整切除总数的40%.肿瘤切除程度和病理类型与术后复发密切相关.良、恶性肿瘤完整切除的5年生存率分别为83.6%和27.3%.恶性肿瘤完整切除的患者平均随访36个月(5～168个月),53%局部复发,平均复发时间25个月(3～108个月),恶性肿瘤局部复发再手术完整切除率62.5%.全组有1例术后第1天腹腔内出血死亡.结论 应当重视临床表现争取早期诊断;影像学检查是判断手术范围的重要依据;肿瘤完整切除,必要时联合脏器切除是治疗本病的最佳手段;术后规律复查有助于及早发现复发肿瘤并争取再手术治疗.     

原发性腹膜后肿瘤诊断和治疗（附81例报告）

目的　探讨原发性腹膜后肿瘤 (PRT)的诊断与外科治疗经验。方法　分析 1980～2 0 0 0年共收治的 81例原发性腹膜后肿瘤。其中良性 34例 ,恶性 47例 ,均经组织病理学证实 ,77例施行手术治疗。观察腹膜后肿瘤在临床表现、影像学检查、病理类型、手术切除及复发等方面的特点。结果　B型超声、CT检查有助于原发性腹膜后肿瘤的早期发现。良性腹膜后肿瘤病程长 (17.5个月 ) ,完整切除率高 (85 .2 9% ) ,很少合并脏器切除 (17.6 5 % ) ;而恶性肿瘤病程短 (7.3个月 ) ,完整切除率低 (6 5 .12 % ) ,合并脏器切除率高 (2 7.91% )。腹膜后肿瘤复发率 19.30 % ,复发完整切除率达6 3.6 3%。结论　B型超声及CT检查是诊断本病的主要手段 ,手术完整切除肿瘤是治疗的主要手段 ,对复发肿瘤亦应争取再次手术。     

原发性盆部腹膜外肿瘤84例的外科治疗

目的　探讨原发性盆部腹膜外肿瘤的外科治疗经验及技巧。方法　回顾性分析原发性盆部腹膜外肿瘤 84例临床资料 ,其中良性 33例 ,低度恶性 33例 ,高度恶性 18例。术前 6例行血管造影并髂内动脉栓塞。经腹、经骶及位腹骶入路切除者分别 5 8、16、10例。结果　 84例均进行手术治疗 ,其中 1例半年内 4次手术切除肿瘤。 6 8例达肿瘤全部切除 (81% ) ,其中良性肿瘤切除率为 94 %(31/33)。行盆腔脏器联合切除者 35例 ,其中全盆腔脏器切除 2例、前盆腔脏器切除 2例。行髂总、髂外血管切除共 5例 ,均行人造血管移植 ;髂内动脉结扎 10例。术中出血最多 15 0 0 0ml,平均 2 385ml。切除肿瘤最大 30cm× 30cm× 2 5cm ,无手术死亡 ,并发症发生率 7% (6 /84 )。术后 37例获随访 ,平均随访 5 4个月 ,仅 1例死亡 ,2 1例复发者再行 2 2例次手术 ,其中 1例术后多次复发共行 7次手术存活12年。结论　联合切口及联合脏器切除 ,必要时行髂血管移植 ,分次切除及复发后再切除 ,是原发性盆部腹膜外肿瘤治疗的有效手段     

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目的 探讨原发性腹膜后肿瘤（PRT）的外科治疗经验。方法 分析1970-2000年经手术治疗的99例PRT,观察其手术切除及复发等特点。结果 良性46例,恶性53例。均经组织病理学证实,良性腹膜后肿瘤;完整切除率高（89.13%),很少合并脏器切除（19.56%),术中失血少（术中平均输血1030mL）;而恶性肿瘤的完整切除率低（56.60%),合并脏器切除率高（32.07%),术中失血多（术中平衡输血1520mL）。腹膜后肿瘤复发率14.04,复发完整切除率达64.28%。结论 手术完整切除肿瘤是治疗的主要手段。对复发肿瘤迹应争取再次手术。     

原发性腹膜后肿瘤的诊断和治疗

目的　总结和探讨原发性腹膜后肿瘤的诊断和治疗经验。方法　回顾性分析 86例原发性腹膜后肿瘤的诊断方法和手术方式的临床资料。结果　 86例中恶性肿瘤 6 2例 ,肿瘤完整切除率 5 9% ,合并脏器切除率 5 8.1% ;良性肿瘤 2 4例 ,肿瘤完整切除率 79.2 % ,合并脏器切除率 8.3%。重复手术 2 4.7%。结论　B型超声和CT是早期诊断原发性腹膜后肿瘤较好的影像学检查方法 ,外科手术治疗及肿瘤完整切除是治疗和预后的关键 ,复发性肿瘤应积极再次手术。     

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.     

腹膜后软组织肉瘤复发的再手术治疗：附25例报告

目的 探讨复发性腹膜后软组织肉瘤的诊断和再手术治疗.方法 回顾性分析收治的手术后复发并再次手术的25例复发性腹膜后软组织肉瘤的临床资料.结果 25例复发性腹膜后软组织肉瘤均经手术及病理证实,因多次复发(1～5次,平均1.68次/例),共行手术42次,包括完整切除26次,部分切除11次,探查活检5次.手术中联合脏器切除共19例,合并大血管切除共5例.末次术后1,3,5年生存率分别是52.0%,40.0%,28.0%.累及重要血管的肿瘤的完整切除率(35.7%)比未累及重要血管(75.0%)者明显降低(P=0.013),而肿瘤是否累及临近脏器对手术完整切除率没有影响(P=0.462).结论 影像学检查对术前评估和手术切除范围有重要意义.对于复发性腹膜后软组织肉瘤,只要无明显手术禁忌,就应积极予以手术切除.     

原发性腹膜后肿瘤的手术治疗

目的探讨原发性腹膜后肿瘤（primary retroperitoneal tumor，PRT）的手术方法，以提高其手术效果。方法回顾性分析1998年5月～2005年4月经手术及病理证实的42例PRT，其中恶性肿瘤17例，良性肿瘤25例。结果完整切除率32例（76．2％），其中联合脏器切除13例，部分切除7例，未切除取活检3例。恶性且中瘤复发再手术6例，再手术完整切除3例。恶性肿瘤1、3、5年生存率分别为58．8％、41．2％、24．1％。结论合理选择手术方法、肿瘤完整切除、复发后再手术可提高PRT生存率。     

原发性腹膜后巨大肿瘤切除术中大血管的处理

目的　通过回顾性地研究近 15年手术切除原发性腹膜后巨大肿瘤的经验 ,总结术中大血管的处理方法和技巧对预后及术后并发症的影响。方法　对近 15年完整切除的 5 6例原发性腹膜后巨大肿瘤术中处理过程进行归纳分析 ,总结肿瘤生长部位对腹腔大血管处理的影响和处理受累大血管的技巧。结果　累及左、中、右和左右腹部的原发性腹膜后巨大肿瘤的切除率分别为 87.5 %、35 .7%、5 2 .2 %和 2 6 .7%。结扎切断脾血管 2 3例次 ,修补大血管 14例次。 4例次为意外紧急处理 ,其余均为预防性程序性处理 ;术后死亡 1例。血管修补组与同期血管壁残瘤组 2 8例比较 ,2年复发率分别为 14.3%和 5 3.6 % ,差异显著 ,P <0 .0 1。结论　对于累及腹腔大血管的原发性腹膜后巨大肿瘤 ,左侧大血管较易处理 ,手术切除率明显高于右侧 ;仔细结扎切断脾血管和预防性地切除受累大血管壁再行修补血管是保证手术安全性、提高腹膜后巨大肿瘤切除率、减少复发率的重要操作步骤。     

Management of primary and recurrent soft-tissue sarcoma of the retroperitoneum.

From 1982 to 1987, 114 patients underwent operation at Memorial Sloan-Kettering Cancer Center for soft-tissue sarcoma of the retroperitoneum. A retrospective analysis of these patients defines the biologic behavior, surgical management of primary and recurrent disease, predictive factors for outcome, and impact of multimodality therapy. Complete resection was possible in 65% of primary retroperitoneal sarcomas and strongly predicts outcome (p less than 0.001). The rate of complete resection was not altered by histologic type, size, or grade of tumor. These patients had a median survival of 60 months compared to 24 months for those undergoing partial resection and 12 months for those with unresectable tumors. Forty-nine per cent of completely resected patients have had local recurrence. This is the site of first recurrence in 75% of patients. These patients undergo reoperation when feasible. Complete resection of recurrent disease was performed in 39 of 88 (44%) operations, with a 41-month median survival time after reoperation. Tumor grade was a significant predictor of outcome (p less than 0.001). High-grade tumors (n = 65) were associated with a 20-month median survival time compared to 80 months for low-grade tumors (n = 49). Gender, histologic type, size, previous biopsy, and partial resection versus unresectable tumors did not predict outcome by univariate analysis. Adjuvant radiation therapy and chemotherapy could not be shown to have significant impact on survival. Concerted attempt at complete resection of both primary and recurrent retroperitoneal soft-tissue sarcoma is indicated.     

Management of retroperitoneal sarcomas

The records of 116 adult patients who underwent operative treatment for retroperitoneal sarcomas at the Mayo Clinic during the years 1963 to 1982 were reviewed. Clinical, pathologic, and treatment variables were analyzed for their influence on recurrence and death from disease. Leiomyosarcomas, liposarcomas, and malignant fibrous histiocytomas represented 93% of the tumors. The primary tumor was completely excised in 54% of patients. Recurrent tumor developed in 68% of patients (median time to recurrence, 1.3 years). Tumor fixation to adjacent structures (T3 tumor) or a high-grade tumor (G2-4) identified patients at increased risk for recurrent disease. Five-year and 10-year survival rates were 40% and 22%, respectively. Survival was significantly better for patients who had (1) complete surgical excision of their tumors, (2) low-grade tumors (G1), (3) tumors not fixed to adjacent retroperitoneal structures (T1 and T2 sarcomas), and (4) tumors without metastases when initially seen. Complete surgical excision offers patients with retroperitoneal sarcomas the best chance for long-term survival, but recurrent disease remains a vexing problem. The therapeutic challenges in the treatment of retroperitoneal sarcomas continue to be the development of therapy that will increase the rate of complete resection, decrease the rate of local recurrence, and enhance patient survival.     

原发性腹膜后肿瘤术后复发的再手术治疗

目的提高复发性腹膜后肿瘤的手术切除率和生存率。方法回顾性分析了我院１９８７年至１９９５年原发性腹膜后肿瘤术后复发而再手术治疗的患者３４例,其中恶性肿瘤３３例,良性肿瘤１例。共行手术５３次,完整切除肿瘤４２次（７９．２％）,姑息切除８次（１５．１％）,探查活检３次（５．７％）。结果复发性腹膜后肿瘤患者肿瘤完全切除者,１、２年生存率分别为７１．２％和６５．３％,而姑息切除和探查活检者均在１年内死亡。结论重视复发性腹膜后肿瘤的术前诊断、准备及术中处理是确保手术安全和提高生存率的关键,强调对复发性腹膜后肿瘤应积极争取完整手术切除。     

Improved survival following complete excision of retroperitoneal sarcomas.

Charts and slides of 47 patients with primary retroperitoneal sarcomas (excluding pediatric rhabdomyosarcoma) were reviewed to determine clinical presentation, histologic features, extent of surgical resection, operative morbidity and mortality, use of radiation and/or chemotherapy, and survival data. Most patients presented with pain and a palpable mass. Leiomyosarcomas and liposarcomas were the most common tumors. Eighteen of the 47 patients (38%) had complete tumor excision; 68% required resection of adjacent organs. Operative morbidity was 33% with no mortality. After complete resection, the disease-free 5-year survival was 50% and the overall survival was 70% at 5 years; 10-year disease-free survival was 25% with an overall 58% survival at 10 years. Eleven patients (61%) developed recurrent disease with a median interval of 5 years following complete excision. Six patients received adjuvant radiation and/or chemotherapy with four remaining disease-free from 46 to 61 months. Eighteen patients underwent partial excision of tumor and 11 patients underwent biopsy only; these groups had similar survival curves with only 4% alive at 5 years. Their operative morbidity was 18% and mortality was 7%; median time to clinical evidence of tumor progression was 12 months. Sixty per cent of these patients received therapeutic radiation and/or chemotherapy, but their survival was the same as those undergoing surgery alone. These data emphasize the importance of an aggressive surgical approach in the treatment of retroperitoneal sarcomas. Complete tumor resection and total excision of recurrences will allow many patients long-term survival.     

Surgical indication for T1N2 disease: comparison of survival among resected T1N2, T2 N2 and non-resected T1 (M0) disease]

Based on the outcome of 28 patients with pathologically confirmed T1N2 disease who underwent surgical resection, we evaluated surgical indication for this stage. Twenty three patients underwent complete resection and 5 patients incomplete resection. The histologic type of tumor was adenocarcinoma in 20 patients and squamous cell carcinoma in 8 patients. The 5-year survival rate was 22% for all resected patients and 28% for completely resected patients. These survival rates were better than those (16% and 23%, respectively) in patients with T2N2 disease. However, there was no significant difference of survival among incompletely resected T1 N2, and non-resected T1 (M0) patients. Although 9 of 28 T1N2 patients survival more than 3 years, all but one patient underwent complete resection of tumor and had clinical N0 or N1 before surgery. In conclusion, surgery should be indicated only for patients with completely resectable tumor, even in T1N2 disease.     

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??Reoperative surgical principle and methods of recurrent retroperitoneal soft tissue tumor SUO Jian, WANG Da-guang, LI Wei. Department of Gastrointestinal Surgery, the First Hospital of Jilin University, Changchun 130021, China
Abstract Because of distorted anatomical structure and severe invasion into vascular and surrounding organs in comparison with primary retroperitoneal tumors, the reoperative surgical managements of recurrent retroperitoneal soft tissue tumors are more difficult and risky. Currently, there is no other effective curative treatment method except surgery. Adopting positive surgical method and complete resection as far as possible is still beneficial to the patients.     

Primary retroperitoneal tumors. Treatment modality and prognostic factors

BACKGROUND: Primary Retroperitoneal Tumors (PRT) form a heterogeneous group of malignant mesenchymal and neuroectodermal neoplasms making up only 1% of all solid neoplasms. METHODS: From 1965 to 1997, 27 patients (16 females and 9 males, age range 19-79 years) underwent operations at the General and Cardiovascular Institute of University of Milan for primary retroperitoneal tumors (22 malignant and 5 benign, sarcomas represented 68% of all malignant tumors). A retrospective analysis of these patients was performed to determine the prognostic parameters associated with a favourable prognosis. All patients were admitted with severe abdominal pain or a palpable mass, other symptoms included fewer and weight loss. The median duration of symptoms before presentation was 16 months (range 15 days-5 years). Before surgical treatment abdominal and pulmonary CT scanning and MRN were undertaken on all patients with PRT to define the size of the tumor and the involvement of other retroperitoneal structures. RESULTS: Complete resection was possible in 54% of malignant tumors (n = 12), incomplete resection was performed in 14% (n = 3) and in 31% (n = 7) only biopsy was possible. Recurrent tumor developed in 25% of patients with total resection (n = 3), (median time to recurrence 5 years). Independent treatment variables (size, signs and symptoms, histopathologic findings and grade) and treatment-dependent variables (type of surgical treatment and adjuvant chemotherapy) were analyzed. Patients with complete resection had a 12 month survival of 100% (n = 12) compared to 50% (n = 1) for those undergoing partial resection and 14.2% (n = 1) for those with simple biopsy. A 24-month survival of the patients undergoing complete resection was 25% (n = 3). Median survival for type of surgical treatment was 28 months for complete resection compared to 14 months for partial resection and only 8 months for biopsy. Twelve-months survival for tumor grade was 100% (n = 7) for low grade tumor (G1), compared to 66.6% (n = 4) for median differentiated tumors (G2), and 37.5% (n = 3) for high grade tumors (G3). Twenty-four-months survival was 28.5% (n = 2) for low grade tumors compared to 16.6% (n = 1) of median differentiated tumors. High grade tumors were associated with a 35-month median survival time compared to 17 months for median differentiated tumors and 10 months for low grade tumors. Other variables (histopathologic findings, size, symptoms) had not significant impact on survival. Operative mortality rate was 3.7% (n = 1). The overall 2 years survival rate in patients with totally resected tumors was 25% (n = 3), (2G1, 1G2), while the 5 year survival rate was 16.6% (n = 2), (2G1). CONCLUSIONS: Complete surgical excision and low grade of the tumor are the most important parameters of survival. Recurrent disease is a vexing problem; a careful and prolonged follow-up based on the use of CT and MRN is recommended.