【摘要】 目的 探討外科手術(shù)治療原發(fā)性腹膜后腫瘤的方法和影響患者預(yù)后的因素?！》椒ā』仡櫡治?002年5月-2008年5月收治的70例原發(fā)性腹膜后腫瘤患者的臨床表現(xiàn)、影像學(xué)檢查、手術(shù)治療及隨訪情況?！〗Y(jié)果 70例患者均進(jìn)行了手術(shù)治療，其中良性腫瘤20例（28.57%），惡性腫瘤50例（72.43%），良惡之比為1∶2.5；完整切除腫瘤者58例（82.86%），腫瘤部分切除者7例（10%），腫瘤廣泛轉(zhuǎn)移行組織活檢者5例（7.14%），聯(lián)合器官切除者18例（25.71%）。術(shù)后隨訪1~5年惡性腫瘤患者45例，其中腫瘤完全切除組1、3、5年的生存率分別為91.67%、66.67%、22.22%，腫瘤部分切除組分別為66.67%、33.33%、0%。兩組比較差異有統(tǒng)計(jì)學(xué)（Plt;0.01）。研究發(fā)現(xiàn)腫瘤的大小、病理類(lèi)型、是否完整切除是影響腫瘤局部復(fù)發(fā)、患者生存率的重要因素?！〗Y(jié)論 早期診斷、充分的術(shù)前準(zhǔn)備、腫瘤的全切除率能顯著改善患者術(shù)后遠(yuǎn)期生存率。【Abstract】 Objective To investigate the surgical management for primary retroperitoneal tumors (PRT) and the factors influencing the prognosis after operation. Methods The clinical manifestation, image data, treatment and prognosis of 70 patients with primary retroperitoneal tumor from May 2002 to May 2008 were retrospectively analyzed. Results All of the patients with PRT had undergone the operations, in whom 20 (28.57%) had benign tumors and 50 (72.43%) had malignant tumors with a ratio of 1:2.5. Among these patients, 58 (82.86%) had complete resection, 7 (10%) had incomplete resection, five (7.14%) had surgical biopsies and 18 (25.71%) had combined resection of the organs. A total of 45 patients with malignant tumors were followed up for one month to five years. The one-, three-, and five-year survival rates of the patients in complete resection group was 91.67%, 66.67% and 22.22%, respectively; and was 66.67%, 33.33%, and 0%, respectively in incomplete resection group. The differences between the two groups were significant (Plt;0.001). The results showed that the completeness of tumor, sizes, and histological type were associated closely with local recurrence and prognosis. Conclusion Early diagnosis, sufficient preoperative preparation and complete tumor resection play important roles in reducing the recurrence and improving the long-term survival rate.
目的探討人造胸水和術(shù)中超聲造影輔助下超聲引導(dǎo)的經(jīng)皮射頻消融治療肝穹窿部腫瘤的安全性和可行性。 方法回顧性分析2008年1月至2009年6月期間四川大學(xué)華西醫(yī)院肝膽胰外科在術(shù)中超聲造影和人造胸水輔助下行經(jīng)皮射頻消融治療的9例肝穹窿部肝癌患者的臨床資料，并對(duì)圍手術(shù)期和隨訪復(fù)發(fā)情況進(jìn)行分析。結(jié)果9例患者共12個(gè)病灶均成功完成了人造胸水輔助下的射頻消融治療。注入胸水量為（2 444±464） ml(2 000~3 000 ml); 每例患者消融時(shí)間為12~24 min(中位數(shù)12 min)，每個(gè)腫瘤為（15±5） min。術(shù)中未發(fā)生血胸、氣胸等，無(wú)手術(shù)相關(guān)死亡發(fā)生。術(shù)后1例患者出現(xiàn)腹腔中量積液約2 000 ml，考慮與低蛋白血癥有關(guān)，補(bǔ)充人血白蛋白后于術(shù)后第4天腹水消失。胸腔引流液總量為（717±372） ml (250~1 420 ml)，術(shù)后3~5 d拔除引流管。術(shù)后隨訪時(shí)間為7~23個(gè)月（中位數(shù)15個(gè)月）。有3例患者分別在術(shù)后5、6和7個(gè)月出現(xiàn)復(fù)發(fā)病灶，其中2例分別經(jīng)介入和保守治療后病情穩(wěn)定，1例術(shù)后6個(gè)月復(fù)發(fā)患者因高血壓心臟病和肝功能惡化于術(shù)后16個(gè)月死亡。 其余患者在隨訪期內(nèi)均存活，未見(jiàn)復(fù)發(fā)、轉(zhuǎn)移。結(jié)論術(shù)中超聲造影和人造胸水輔助經(jīng)皮射頻消融治療肝穹窿部肝癌安全、有效，有較高臨床應(yīng)用價(jià)值。