腹腔镜联合术前介入栓塞在原发性腹膜后肿瘤中的应用体会  

Application of laparoscopy combined with preoperative interventional embolization in primary retroperitoneal tumors

作　　者：朱超[1,2] 石小强 郭海南 冯骏 李徐奇[1] 王曙逢[1] ZHU Chao;SHI Xiao-qiang;GUO Hai-nan(Department of General Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Xi'an Jiaotong University Health Science Center)

机构地区：[1]西安交通大学第一附属医院普通外科,陕西西安710061 [2]西安交通大学医学部 [3]西安交通大学第一附属医院血管外科

出　　处：《腹腔镜外科杂志》2023年第3期204-208,213,共6页Journal of Laparoscopic Surgery

摘　　要：目的:探讨经腹腔入路腹腔镜手术联合术前介入栓塞在原发性腹膜后肿瘤中的临床应用。方法:回顾分析2019年5月至2021年4月为24例患者行术前介入栓塞联合经腹腔入路腹腔镜原发性腹膜后肿瘤切除术的临床及病理资料,观察术中情况、术后恢复、随访及生存情况。结果:17例行完全腹腔镜腹膜后肿瘤切除术,5例因重要血管骑跨、被肿瘤包绕或粘连严重中转开腹,2例经腹腔镜辅助小切口完成切除术。肿瘤肉眼完整切除(R0/R1)23例,其中6例联合脏器切除;1例腹腔镜探查见多处侵犯无法根治切除,中转开腹行肿瘤部分(R2)切除。手术时间平均(361±137.6)min,术中出血量200(100,575)mL,术后住院7.5(6,9.75)d。术后发生轻度并发症6例,无围术期死亡病例。22例患者获得随访,随访17~40个月,中位随访25.5个月,1例高分化脂肪肉瘤合并粘液样脂肪肉瘤患者于术后24个月复发,予以保守治疗,术后26个月肾衰竭死亡;1例血管平滑肌脂肪瘤,术后21个月因冠心病死亡;余者均无瘤生存。结论:经充分评估后行术前介入栓塞联合经腹腔入路腹腔镜原发性腹膜后肿瘤切除术安全、可行,复杂腹膜后肿瘤建议行术前栓塞治疗。Objective:To investigate the clinical application of transabdominal laparoscopic operation combined with preoperative interventional embolization in the primary retroperitoneal tumors.Methods:Retrospective analysis was made on the clinical and pathological data of 24 patients who underwent preoperative interventional embolization combined with laparoscopic resection of primary retroperitoneal tumors through the abdominal approach from May 2019 to Apr.2021,intraoperative condition,the recovery after the operation,followup and survival were observed.Results:Seventeen patients underwent complete laparoscopic retroperitoneal tumor resection;5 cases were converted to laparotomy due to important blood vessels straddling,tumor wrapping or severe adhesion;small incisionassisted laparoscopy was performed in 2 cases.Gross complete resection of tumors(R0/R1)was performed in 23 cases,of which 6 cases underwent combined organ resection;one case with multiple invasions which could not be radical resected by laparoscopy was converted to laparotomy for partial tumor resection(R2).The operation time was(361±137.6)min,the intraoperative blood loss was 200(100,575)mL,and the postoperative hospital stay was 7.5(6,9.75)d.A total of 6 patients had mild complications and no perioperative death.22 patients were followed up for 17 to 40 months,with a median follow-up of 25.5 months.During the follow-up period,one case of well differentiated liposarcoma combined with myxoid liposarcoma recurred 24 months after the operation,the patient was given conservative treatment,and died of renal failure 26 months after the operation;one case of angiomyolipoma died of coronary heart disease 21 months after the operation;other patients survived without any tumors.Conclusions:After the full evaluation,preoperative interventional embolization combined with transabdominal laparoscopic resection of primary retroperitoneal tumors is safe and feasible,and preoperative embolization is recommended for complex retroperitoneal tumors.

关 键 词：原发性腹膜后肿瘤 腹腔镜检查 介入栓塞 

分 类 号：R735.4[医药卫生—肿瘤]