单侧肿瘤和腹膜后脂肪切除+腹腔热灌注化疗治疗腹膜后脂肪肉瘤的临床研究  

Clinical study of unilateral tumour and retroperitoneal fat resection and hyperthermic intraperitoneal chemotherapy for retroperitoneal tumour

作　　者：苗成利[1] 陈伟达[1] 刘文庆 黄梅 邹博远 李文杰 高海成 刘世博 MIAO Chengli;CHEN Weida;LIU Wenqing;HUANG Mei;ZOU Boyuan;LI Wenjie;GAO Haicheng;LIU Shibo(Department of Retroperitoneal Tumor Surgery,Peking University International Hospital,Beijing 102206,China)

机构地区：[1]北京大学国际医院腹膜后肿瘤外科,北京102206

出　　处：《中国研究型医院》2022年第4期14-17,共4页Chinese Research Hospitals

基　　金：北京市科委课题(Z161100000516025);北京大学国际医院院内重点课题(YN2021ZD04);北京大学国际医院院内重点课题(YN2017ZD03)。

摘　　要：目的探讨单侧肿瘤和腹膜后脂肪切除+腹腔热灌注化疗(HIPEC)治疗腹膜后脂肪肉瘤(RPLS)的效果。方法搜集2015年1月—2018年12月133例RPLS患者的病例资料进行回顾性研究。根据手术方法的不同将其分为3组,A组:单纯肿瘤切除术;B组:A组基础上+腹膜后脂肪切除(单侧);C组:B组基础上+HIPEC治疗。采用Kaplan-Meier法绘制生存曲线,分析平均总生存期(OS);采用Log-rank检验进行单因素分析,观察每组患者的术中出血量和肿瘤大小的关系,记录患者基本情况及术后随访情况。结果3组平均OS分别是:A组(25.31个月,95%CI:21.32~29.30个月);B组(31.35个月,95%CI:28.23~34.48个月);C组(36.92个月,95%CI:36.10~37.74个月)。相对于A组、B组,C组的总生存率最有优势(P值均<0.05)。采用COX比例风险回归模型对P<0.10的变量进行多因素分析显示,A组患者死亡风险显著高于C组(HR=15.622>1,P=0.000<0.05);B组患者死亡风险显著高于C组(HR=4.198>1,P=0.015<0.05),故治疗方法是影响OS的独立因素。3组患者术中出血量与肿瘤最大直径呈线性关系,但3组间的出血量比较差异无统计学意义(P值均>0.05)。结论采用单侧肿瘤切除+腹膜后脂肪切除+HIPEC治疗能够提高初次或再次手术的RPLS患者的OS,且不增加出血量。Objective To investigate the effect of unilateral tumour and retroperitoneal fat resection+hyperthermic intraperitoneal chemotherapy(HIPEC)in treating retroperitoneal liposarcoma(RPLS).Methods A retrospective study was performed on 133 cases of patients with RPLS from January 2015 to December 2018.The enrolled patients were divided into three groups according to the surgical method,group A:tumour resection;group B:tumour resection+retroperitoneal fat dissection(unilateral);group C:tumour resection+retroperitoneal fat dissection(unilateral)+HIPEC.The Kaplan-Meier method plot the survival curves and analyse the mean overall survival(OS).The Log-rank test was used for univariate analysis to observe the relationship between intraoperative bleeding and tumour size in each group and to record the basic information of patients and postoperative follow-up.Results The mean OS rates of the three groups were:group A(25.31 months,95%CI:21.32-29.30 months);group B(31.35 months,95%CI:28.23-34.48 months);group C(36.92 months,95%CI:36.10-37.74 months).Group C had the best overall survival rate compared with groups A and B(P<0.05).Multivariate analysis of P<0.10 by the COX proportional risk regression model showed that the risk of death in group A was significantly higher than that in group C(HR=15.622>1,P=0.000<0.05).The risk of death in group B was significantly higher than group C(HR=4.198>1,P=0.015<0.05),so the treatment method was an independent factor affecting OS.There was a linear relationship between intraoperative bleeding and maximum tumour diameter in patients of group B,but there was no statistically significant difference in the comparison of bleeding among the 3 groups(all P>0.05).Conclusion Total retroperitoneal fat resection(unilateral)+HIPEC can improve the OS of RPLS patients undergoing primary or secondary surgery without increasing bleeding.

关 键 词：腹膜后肿瘤 脂肪肉瘤 化学疗法 肿瘤 局部灌注 预后 

分 类 号：R735.4[医药卫生—肿瘤]