侵及胸腹部大血管肿瘤患者的临床治疗

目的 探讨侵及胸腹部大血管肿瘤患者的治疗过程中,血管外科技术的临床应用经验.方法 回顾性分析2001年1月至2009年6月北京大学人民医院血管外科应用血管外科技术手术治疗的67例侵犯胸腹部大血管肿瘤住院患者临床资料.其中单纯侵犯血管壁者31例,血管内瘤栓者20例,侵犯血管壁合并瘤栓者16例.结果 67例患者均接受手术治疗,术式包括肿瘤血管粘连松解15例,血管切除缝合24例,人工血管补片10例,心包补片3例,人工血管置换或转流15例,腔内瘤栓取栓36例,其中8例侵犯右心房者在体外循环下完成手术.肿瘤根治性切除58例,姑息性切除9例,完整切除率为86.6％,无术中死亡,围术期死亡8例.获随访52例,失访7例,随访率88.1％.截至2009年6月,本组病例术后生存期48个月以上18例,24个月以上29例,12个月以上38例,6个月以上50例,6个月以下2例,死亡原因多为肿瘤全身转移,疗效最好的恶性肿瘤为肾癌.结论 肿瘤累及大血管时可以通过多种血管外科技术的综合运用提高肿瘤切除成功率和改善术后生存质量.

Surgical strategies for tumors with invasion of thoracic and abdominal great vessels

Objective To summarize the vascular surgical strategies for chest and abdomen tumors with the invasion of great vessels.Methods The clinical data were collected for 67 patients undergoing surgical treatment for tumors with the invasion of thoracic and abdominal great vessels at our hospital from January 2001 to June 2009.Then a retrospective analysis was performed.Among this dataset,there were 31 cases with only vessel wall invasion and 20 cases with only intravascular tumor thrombus.In the meanwhile,both the invasion of vascular walls and the formation of tumor thrombus were located in 16 patients.Results Among 67 operated patients,various strategies were used,including surgical adhesion lysis ( n =15 ),vascular resection direct suture (n =24),artificial blood vessel patch (n =10),pericardial patch (n =3),artificial vascular replacement or bypass (n =15 ) and cavity thrombectomy ( n =36).Cavity thrombectomy was performed under cardiopulmonary bypass for 8 patents with tumor invasion of right atrium.Among them,58 patients received radical tumor resection while palliative resection was performed for 9 patients with a rateof complete resection at 86.6％.There was no intraoperative mortality with the perioperative death of 8 cases.A follow-up study was successfully conducted for 52 patients.And 7 patients were lost to follow-up.The overall follow-up rate was 88.1％.By June 2009,the survival period of this group of patients was as follows:18 cases ( ＞48 months),29 cases ( ＞24 months),38 cases ( ＞ 12 months),50 cases ( ＞6 months) and 2 cases (≤6 months).Among these patients,the major cause of mortality was tumor metastasis.The patients with kidney cancer showed the most favorable surgical outcomes.Conclusion Managed by a variety of vascular surgical techniques,the patients with tumors involving major blood vessels may achieve an excellent success rate of tumor resection and a better postoperative quality-of-life.