经腹入路腹腔镜在原发性腹膜后肿瘤切除术中的应用研究  

Laparoscopic resection for primary retroperitoneal tumor via transabdominal approach

作　　者：厉学民 於敏 周海华 李仓 程俊峰 俞世安 LI Xuemin;YU Min;ZHOU Haihua;LI Cang;CHENG Junfeng;YU Shian(Department of Hepatopancreatobiliary Surgery,Affiliated Jinhua Hospital of Zhejiang University School of Medicine,321000 Jinhua,China)

机构地区：[1]浙江大学医学院附属金华医院肝胆胰外科,321000

出　　处：《浙江医学》2022年第3期296-298,302,共4页Zhejiang Medical Journal

摘　　要：目的探讨经腹入路腹腔镜在原发性腹膜后肿瘤切除术中的应用价值。方法对2014年8月至2019年12月浙江大学医学院附属金华医院收治的21例原发性腹膜后肿瘤患者行经腹入路腹腔镜切除术,观察患者主要临床表现、手术及术后随访情况。结果21例患者中因腹痛5例、腹胀2例、腰痛1例就诊,余13例因体检发现腹部肿物而就诊。肿瘤长径3~16 cm,病理学诊断为良性18例,分别为淋巴管瘤5例、神经鞘瘤4例、Castleman病2例、节细胞神经瘤1例、成熟畸胎瘤1例、副神经节瘤1例、异位嗜铬细胞瘤1例、良性囊性黏液性肿瘤1例、腹膜后囊肿1例、血管脂肪瘤1例;恶性3例,分别为高分化脂肪肉瘤2例,神经内分泌肿瘤1例。有6例患者的肿瘤毗邻重要血管和脏器。21例患者均顺利完成经腹入路腹腔镜腹膜后肿瘤切除术,其中2D腹腔镜下手术15例,3D腹腔镜下手术6例。手术时间平均为130 min,术中出血量平均为125 ml,术后住院时间平均为7 d。术后并发胃排空障碍1例、乳糜漏1例,均经对症处理后好转,无围术期死亡病例。术后随访3~64个月均无肿瘤复发。结论经腹入路腹腔镜原发性腹膜后肿瘤切除术是安全可行的。Objective To analyze the application of laparoscopic resection for primary retroperitoneal tumor via transabdominal approach.Methods The clinical data of 21 patients with primary retroperitoneal tumor who underwent laparoscopic resection via transabdominal approach at Affiliated Jinhua Hospital of Zhejiang University School of Medicine from August 2014 to December 2019 were retrospectively analyzed.Results Of the 21 patients,5 patients with abdominal pain,2 patients with abdominal distension,one patient with low back pain and 13 patients were treated for abdominal swelling found by physical examination.The range of long diameter of tumor was 3-16 cm.Eighteen benign cases were pathologically diagnosed,including five cases of lymphangioma,four cases of schwannoma,two cases of Castleman disease,one case of ganglioneuroma,one case of mature teratoma,one case of paraganglioma,one case of ectopic pheochromocytoma,one case of benign cystic mucous tumor,one case of retroperitoneal cyst and one case of angioliposoma.Three cases of malignant tumors are two highly differentiated liposarcoma and one neuroendocrine tumor.Six patients had tumors adjacent to vital blood vessels and organs.All 21 patients underwent laparoscopic resection for primary retroperitoneal tumor via transabdominal approach successfully.Among 21 patients,15 were completed surgery with 2D laparoscope,6 were completed surgery with 3D laparoscope.The mean operation time was 130 min,the mean intraoperative blood loss was 125 ml,the mean length of postoperative hospital stay was 7 d.Two patients had postoperative complications including 1 case of delayed gastric emptying and 1 case of chylous fistula,which were improved by symptomatic treatment.Patients were followed up for 3-64 months,there was no perioperative death,and no recurrence.Conclusion Laparoscopic resection for primary retroperitoneal tumor via transabdominal approach is safe and feasible.

关 键 词：腹腔镜 经腹入路 原发性腹膜后肿瘤 

分 类 号：R735.4[医药卫生—肿瘤]