目的 探讨微波固化在腹膜后肿瘤手术中止血的可行性。方法 对我院2008年7月至2009年8月期间收治的9例腹膜后肿瘤患者手术中应用微波固化止血。手术暴露瘤体后，应用微波治疗仪多点固化瘤体。手术切除肿瘤，不能完整切除者则再次应用微波治疗仪固化瘤床创面，尽量灭活残余肿瘤。结果 9例患者肿瘤切除后创面几乎无渗血，术中失血量（275.56±81.26） ml，手术时间（150.56±36.18） min，住院时间（14.67±2.30） d，无术后并发症发生。术后随访（10±3.97)个月，9例患者均未见复发。结论 腹膜后肿瘤手术过程中应用微波固化止血效果良好。
Objective To summarize the experience in diagnosis and treatment of primary retroperitoneal tumor (PRT). Methods Clinical data of 69 patients with PRT from June 1998 to June 2008 were analyzed retrospectively. Results Bellyache, abdominal distention, and abdominal mass were common symptoms in the patients with PRT. Ultrasound, CT, and MRI examination were effective. The major histopathological classification was soft tissue tumor, germinoma, lymphatic hematopoietic system tumors, and other rare tumors. Complete resection of tumors was performed in 42 cases, combined organs resection in 10 cases, partial resection of tumors in 11 cases, and only biopsy in 6 cases. There were 10 cases of intraoperative vessel and organ injury, which were treated by repair or vessels suturing and combined organ resection. Postoperative complications occurred in 8 cases, which were cured by conservative treatment. One patient died of hemorrhage acute stress ulcer combined multiple organ failure. The survival rates of 1, 3, and 5 years in patients underwent complete resection of tumors were 71%, 64%, and 46%, respectively. Of 11 patients underwent partial resection of tumors, 8 cases died within one year, and 3 cases died within 3 years after operation. All malignant tumor patients treated by biopsy died within one year after operation.Conclusion Synthetically using imaging examination may diagnose definitely, and to resect tumors as much as possible will improve patients’ survival.
ObjectiveTo discuss the treatment of retroperitoneal tumors infiltrating celiac trunk. MethodFifteen cases of retroperitoneal tumors who underwent surgery in our hospital between December 2014 to December 2015 were reviewed and analyzed. ResultsAll of the 15 cases had underwent operation, and the blood loss was 300-2200 mL (mean of 600 mL), operation time was 125-600 minutes (mean of 240 minutes). Length of stay in cases of celiac trunk resected was 10-23 days (mean of 15.1 days), and length of stay in cases of celiac trunk nonresected was 15-132 days (mean of 35.2 days). Thirty cases of them were complete resection, and 2 cases were mostly resection. Eight cases of them did not injure celiac trunk, 1 case suffered from complication, 7 cases injured celiac trunk and all of them suffered from complication. There were significant statistical difference in incidence of complications (χ2=8.14, P=0.01) in cases of celiac trunk injury or not. All the cases were followed up for 3-13 months (mean of 6.3 months), 2 cases recurred during the follow-up period, 1 case was leiomyosarcoma, and another 1 was malignant fibrous histiocytoma who underwent celiac trunk resection. ConclusionsWhen retroperitoneal tumors infiltrates celiac trunk, we can resect the celiac trunk, but we must follow a certain principle.
ObjectiveTo investigate the effectiveness of retroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis. MethodsA retrospective analysis was made on the cl inical data of 22 patients with lumbar spine tuberculosis undergoing focus clearance, fusion, and internal fixation by retroperitoneal laparoscopic approach combined with anterolateral mini-incision between June 2006 and June 2012. There were 14 males and 8 females, with an average age of 42.6 years (range, 26-57 years) and with a mean disease duration of 7.3 months (range, 3-10 months). There were 17 patients with single-level spinal tuberculosis (L1, 2 in 3, L2, 3 in 6, L3, 4 in 4, L4, 5 in 2, and L5 in 2) and 5 patients with double-level spinal tuberculosis (L1-3 in 2 and L2-4 in 3). The preoperative Cobb's angle of lumbar spine was 5-28° (mean, 20°). In 6 patients having compression symptom, 4 cases were rated as grade D and 2 as grade C according to Frankel classification. The operative time, intraoperative blood loss, and postoperative complications were recorded. At last follow-up, the neurologic function was assessed according to Frankel grade, the Cobb's angle after operation was measured on lumbar lateral X-ray film; the efficacy was evaluated according to Nakai criteria, and the fusion was evaluated according to Suk criteria. ResultsAll operations were successfully completed. The operation time was 110-250 minutes (mean, 140 minutes), and intraoperative blood loss was 120-280 mL (mean, 180 mL). The symptoms of femoral nerve injury and sympathetic nerve injury occurred in 1 case respectively and was relieved at 1-3 weeks after operation. All incisions healed by first intention. The patients were followed up 16-50 months (mean, 21 months). During the follow-up period, no loosening or breakage of implants and no tuberculosis recurrence were found. At last follow-up, the nerve function was recovered to grade E in the others except 1 case at grade D. The Cobb's angle was 2-16° (mean, 7.8°). According to Nakai criteria for efficacy evaluation, the results were excellent in 9 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 86.4%. The bony fusion rate was 95.5% (21/22) according to Suk criteria. ConclusionRetroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis is a safe and effective approach with minimal invasion and less complications.
目的探讨原发性腹膜后肿瘤行腹腔镜手术的安全性和疗效。 方法回顾性分析新疆医科大学第二附属医院普外科2008年4月至2013年4月期间行腹腔镜手术治疗的12例原发性腹膜后肿瘤患者的临床资料。 结果12例患者均行腹腔镜手术，其中1例中转开腹手术，其余行腹腔镜手术成功。平均手术时间190 min，术中平均出血300 mL，术后平均8.5 d出院。术后左下肢深静脉血栓形成1例，经保守治疗好转。围手术期无死亡患者。术后病理类型：良性肿瘤5例，其中神经鞘瘤1例，脂肪瘤1例，腹膜后囊肿2例，畸胎瘤1例；恶性肿瘤7例，其中纤维肉瘤2例，平滑肌肉瘤1例，恶性淋巴瘤2例，脂肪肉瘤2例。良性肿瘤平均直径8.1 cm，恶性肿瘤平均直径5.6 cm。随访7例恶性肿瘤患者，平均随访时间13个月，无复发及转移。 结论通过本组有限的病例资料初步得出，原发性腹膜后肿瘤的诊断主要依靠影像学检查。对于肿瘤直径≤10 cm的良性肿瘤或直径≤6 cm的恶性肿瘤且未侵犯主要血管者行腹腔镜手术治疗安全、可行。
ObjectiveTo evaluate the clinical features of the retroperitoneal paralangliomas. MethodClinical data of 34 patients with retroperitoneal paragangliomas who underwent surgery in our hospital between January 2005 and January 2015 were enrolled, all patients diagnosed by pathological examination. ResultsClinical manifestation: hypertension (n=4) and headache (n=1) were the main symptoms in all 5 patients with functional tumor. Abdominal distension (n=14) or abdominal pain (n=11) were the initial symptoms in patients with nonfunctional tumor, gastrointes-tinal obstruction was observed in 1 patient, the other 3 patients were diagnosed accidently among the 29 patients with nonfunctional tumors. Blood and urine catecholamines increased notly in 5 patients with functional tumor, increased mildly in 2 patients with nonfunctional tumor; and remained at a normal level in the other patients. All the 34 patients underwent surgery, 4 patients with nonfunctional tumors who suffered from vessel wrapped needed tumor resection combining with main vessel resection or reconstruction, 1 of the 4 patients presented with vascular wall invasion. Two patients presented with lymph-vascular invasion of patients didn't received vessel resection or reconstruction. The mean value of diameter of these tumors was (9.5±5.1) cm (3.5-18.5 cm). Twenty four tumors had complete capsule, the other 10 had partial capsule; 32 tumors were well differentiated, and other 2 patients had apparent strange nucleus. Among the 34 patients, G1 tumors were confirmed in 14 patients and G2 tumors were confirmed in 20 patients. All the 34 patients were followed up with a mean value of follow-up time of 52 months (1-105 months). During the follow-up period, 6 patients suffered from recurrence and 6 patients died. The 1-year and 5-year survival rates were 86.0% and 81.5%, respectively. ConclusionsRadical resection may be the only measure to cure retroperitoneal paragangliomas. Tumor combining with vascular resection or reconstruction provide a chance for patients with ‘unresectable tumors’.