论文部分内容阅读
目的探讨下腔静脉平滑肌肉瘤的外科处理方法及临床疗效。方法回顾性分析5例患者临床资料,结合既往腹膜后肿瘤的手术经验,综合文献资料,分析下腔静脉平滑肌肉瘤的治疗要点。结果肿瘤来源于下腔静脉中段的3例,上段和下段各1例。4例按术前计划切除了肿瘤,其中2例达RO切除,分别随访20个月和22个月无复发,1例R1切除术后6个月复发而再次手术,后随访24个月未复发,1例有肝转移行R2切除,术后存活8个月,1例在术中发现肿瘤延及右心房且浸润血管而仅行活检,术后生存仅2个月。3例下腔静脉切除以后未重建,术后无肾功能衰竭等严重并发症。结论术前CT/MRI联合检查,主要进行肿瘤定位,评估手术切除的可能性;造影检查可以明确下腔静脉的走行、通畅程度以及侧支循环情况,可减少术中盲目探查引起的静脉性失血,同时指导下腔静脉切除以后是否需要重建;RO根治性切除是减少复发、延长生存时间的主要手段;术后有短暂的肾功能不全者可以通过血滤很快恢复;术后局部复发的患者可以再次手术,可明显延长生存时间。
Objective To investigate surgical treatment of inferior vena cava leiomyosarcoma and its clinical efficacy. Methods The clinical data of 5 patients were retrospectively analyzed. Combined with the experience of past retroperitoneal tumors and the comprehensive literature, the main points of treatment of IVC myoma were analyzed. Results The tumors originated from the middle of inferior vena cava in 3 cases, and the upper and lower segments in 1 case. Tumor resection was performed in 4 cases according to the preoperative plan. Two of the resected tumors were resected by RO, and were followed up for 20 months and 22 months without recurrence. One case had recurrence 6 months after resection of R1 and reoperation, followed up for 24 months without recurrence , 1 case of hepatic metastases resection of R2, survived for 8 months, 1 case of tumor found in the extension of the right atrium and infiltration of blood vessels and only biopsy, postoperative survival was only 2 months. Three cases of inferior vena cava resection did not reconstruct postoperative renal failure and other serious complications. Conclusions The preoperative CT / MRI combined examination mainly focuses on tumor location and evaluate the possibility of surgical resection. Contrast-enhanced imaging can clearly determine the walking and patency of inferior vena cava and collateral circulation to reduce venous blood loss caused by intraoperative blind exploration , While guiding the need for reconstruction after resection of the inferior vena cava; radical resection of the RO is the main means to reduce recurrence and prolong survival; short-term renal insufficiency can be quickly recovered by blood filtration; patients with local recurrence after operation Can be surgery again, can significantly extend the survival time.