腹腔镜改良性腹膜后淋巴清除术治疗临床Ⅰ期睾丸非精原细胞瘤

目的:探讨腹腔镜改良性腹膜后淋巴清除术初步经验,评估其手术可行性和近期临床疗效。方法:2004年10月~2006年7月,对7例临床诊断为Ⅰ期睾丸非精原细胞瘤患者,施行了经腹腔途径腹腔镜改良性腹膜后淋巴清除术,年龄26~36岁,平均年龄为30岁,睾丸肿瘤大小为3.0 cm×2.5 cm×2.0 cm~6.5 cm×4.5 cm×3.0 cm,左侧3例,右侧4例,均通过B超、腹膜后CT、胸片检查,并施行了根治性睾丸切除和病理证实。术后淋巴结阳性患者施行了3个疗程的化疗。结果:7例均获得成功,无1例改开放手术。手术时间为120~210 min,平均160 min,手术失血量50~200 ml,平均150 ml,均未输血。术后1~3 d肛门排气,于1~2 d拔除引流管;术后平均住院时间5.5 d。病理报告6例均无转移性淋巴结,其中1例为1/18淋巴结转移,术后无明显并发症。随访6~32个月,平均14个月,阴茎勃起功能良好,射精功能正常。定期复查血hCG、AFP均阴性,B超复查均未发现腹膜后淋巴结,胸片表现均正常。其中淋巴结阳性1例患者术后接受3个疗程的辅助化疗,随访6个月,无瘤存活。结论:腹腔镜改良性腹膜后淋巴清除术具有损伤小、并发症少、术后恢复快等特点,可以代替传统开放手术。     

ԭ���Ը�Ĥ�������г�ʱ��ҪѪ�ܵ��ؽ�

目的　探讨累及主要血管的原发性腹膜后肿瘤切除时 ,主要血管的处理方法 ,以提高切除率。方法　总结 4 5例累及主要血管原发性腹膜后肿瘤的切除及血管重建的经验。结果　无手术死亡。随访 4 1例 ,随访时间3～ 87个月 ,平均 4 9个月 ,移植物血栓栓塞 2例 ,其中 1例左髂动脉移植物术后 8个月发生血栓栓塞延误就诊左下肢坏疽行左髋关节解脱。术后 7个月髂静脉移植物血栓栓塞 1例 ,肢体稍肿胀。生存期 >1年者 36例 ,生存期 >3年 33例 ,>5年 6例 ,其余病例尚在随访中。随访过程中 5例肿瘤复发再次切除。结论　对累及主要血管原发性腹膜后肿瘤切除合并大血管重建手术安全 ,可明显提高手术切除率降低复发率 ,延长存活时间。     

改良后腹腔镜手术方式在上尿路肿瘤治疗的可行性和安全性*

目的探讨改良后腹腔镜手术方式在上尿路肿瘤治疗的可行性及安全性。方法回顾性分析该院40例腹腔镜手术治疗肾盂癌及中上段上尿路肿瘤患者病例,其中21例患者选择改良后腹腔镜联合经尿道电切镜下肾、输尿管切除术(A组),另外19例患者采用后腹腔镜联合下腹部小切口、经尿道电切镜肾、输尿管切除术(B组)。比较两种手术方式的手术时间、术中出血量、术后留置引流管时间、术后首次肛门排气时间及术后住院时间的差异。结果两组共40名患者,手术均顺利完成,无中转手术。A组与B组患者平均年龄、性别比、肿瘤位置比较,差异无统计学意义(P0.05)。A组手术时间较B组明显缩短(P0.01);A组患者术后住院时间明显少于B组(P0.05)。两组均无术中、术后并发症。A、B组间术中失血量、术后留置引流管时间、术后首次肛门排气时间均差异无统计学意义(P0.05)。结论和后腹腔镜联合下腹部小切口手术方式相比,改良后腹腔镜手术方式安全有效,可缩短手术时间,减少患者术后住院时间,可在上尿路肿瘤,特别是肾盂及中上段输尿管肿瘤的治疗中选择应用。     

Identification of a clinical web-based nomogram to predict overall survival in elderly retroperitoneal sarcoma patients: A population-based study

The purpose of this study was to develop a web-based nomogram and risk stratification system to predict overall survival (OS) in elderly patients with retroperitoneal sarcoma (RPS). Elderly patients diagnosed with RPS between 2004 and 2015 were identified in the Surveillance, Epidemiology, and End Results (SEER) database. We used univariate and multivariate Cox analysis to identify independent prognostic factors. We plotted the nomogram for predicting the OS of elderly RPS patients at 1, 3, and 5 years by integrating independent prognostic factors. The nomograms were subsequently validated by receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). By calculating the Nomogram score for each patient, we build a risk stratification model to evaluate the survival benefit of elderly RPS patients. A total of 722 elderly RPS patients were included in our study. The nomogram includes 5 clinicopathological variables as independent prognostic factors: age, histological subtype, grade, metastasis status, and surgery. Through the validation, we found that the nomogram has excellent prediction performance. Then web-based nomograms were established. We performed a web-based nomogram and a risk stratification model to assess the prognosis of elderly RPS patients, which are essential for prognostic clustering and decision-making about treatment.     

原发性腹膜后恶性肿瘤的诊断和治疗

【目的】探讨原发性腹膜后恶性肿瘤的诊断及治疗方法。【方法】回顾性分析1994年5月至2004年8月收治的9例原发性腹膜后恶性肿瘤的临床资料。【结果】9例中有5例首发症状为腹部包块。B超阳性率87．5％,CT及MRI阳性率均为100％。病理结果为脂肪肉瘤3例,平滑肌肉瘤2例,恶性淋巴瘤,恶性畸胎瘤,恶性神经鞘瘤,恶性间质瘤各1例。完整切除者6例次,部分切除12例次,活检1例次。完整切除者1、3、5年生存率分另q100％、60％、40％,部分切除者1、3、5年生存率分别为75％、25％、0％。【结论】原发性腹膜后恶性肿瘤术前主要靠影像学检查诊断。手术完整切除是治疗的关键因素,患者复发率高,再次手术仍是治疗复发性膜膜后恶性肿瘤的有效手段。     

Intracranial Dural Sinus Thrombosis: Novel Use of a Mechanical Thrombectomy Catheter and Review of Management Strategies

Management of intracranial dural sinus thrombosis with involvement of multiple sinuses is complex, often involving not only the primary problem (thrombosis) but acute adverse events consequent to the disease. We highlight the novel use of an endovascular device (typically for suction thrombectomy in the peripheral vascular system) used in our patient with a life-threatening multi-sinus thrombosis. As there is no standard treatment yet for cranial sinus thrombosis, our review of the literature highlights some effective management strategies. A 35-year-old woman developed associated complications of cranial sinus thrombosis that included intracranial hypertension caused by an expanding intracranial hematoma, pulmonary embolism treated by placement of filters in superior and inferior vena cava to eliminate intra- and extracranial sources of emboli, and procedure-related retroperitoneal hematoma that necessitated peripheral vascular intervention. After failure of several common devices during mechanical thrombolysis, a thrombectomy catheter (typically for peripheral vascular intervention to aide in the clot removal) was used. Our case highlights the fine balance of anticoagulation and thrombolysis and the proactive, aggressive approach used by our multispecialty team to manage concurrent factors.     

Cardiac metastasis of liposarcoma

The authors describe a retroperitoneal liposarcoma with secondary involvement of the left ventricle. Therapy has been disappointing, and is guided by the nature of the primary tumor, previous therapy, extent of metastatic spread, and feasibility of cardiac resection. In selected patients whose primary tumor is well-controlled and progressing slowly, with no evidence of widespread disease, resection of the cardiac metastases can be performed when technically feasible.     

Retroperitoneoscopic lymphatic management of intractable chyluria

PURPOSE: We present our experience with retroperitoneoscopic lymphatic disconnection for the treatment of patients with intractable chyluria and review the current literature. MATERIALS AND METHODS: Our study included 6 males and 3 females 22 to 55 years old who presented with intractable chyluria of filarial origin and variable duration (2 to 11 years), and were selected for retroperitoneoscopic management of 11 renoureteral units. Diagnosis was based on urine examination for the presence of chyle and fat globules, cystoscopy, excretory urogram and retrograde ureteropyelography. The technique of retroperitoneoscopic management of chyluria consisted of nephrolympholysis, ureterolympholysis, hilar vessel stripping, fasciectomy and nephropexy. The first 3 procedures were done in all cases, whereas fasciectomy was only done in 4 cases and nephropexy in 3 as required. RESULTS: Chyluria disappeared in all ipsilateral renal units of the patients who underwent retroperitoneoscopic management but it recurred in 2 patients at 1 and 9 months of followup from the contralateral side. Both cases have since been successfully treated with contralateral retroperitoneoscopic management. Complications included lymphatic leak through the drain which persisted for 5 days in 1 case and an inadvertent clipping of a branch of the posterior segmental artery of the kidney in 1. The latter patient did not have pain or hypertension and the renal scan did not reveal any focal deficit at followup. All patients were followed periodically from 6 months to 41/2 years (mean of 31 months). CONCLUSIONS: The objectives of open surgical treatment of intractable chyluria can be achieved by the minimally invasive retroperitoneoscopic technique. Nephrolympholysis, ureterolympholysis and stripping of hilar vessels were essential in all cases. Fasciectomy and nephrectomy were done in a few patients and as mentioned are not recommended routinely. This approach has all of the benefits of laparoscopic surgery without compromising the principles of open surgery. Retroperitoneoscopic management was safe, effective and efficient.