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目的 通过回顾性地研究近 15年手术切除原发性腹膜后巨大肿瘤的经验 ,总结术中大血管的处理方法和技巧对预后及术后并发症的影响。方法 对近 15年完整切除的 5 6例原发性腹膜后巨大肿瘤术中处理过程进行归纳分析 ,总结肿瘤生长部位对腹腔大血管处理的影响和处理受累大血管的技巧。结果 累及左、中、右和左右腹部的原发性腹膜后巨大肿瘤的切除率分别为 87.5 %、35 .7%、5 2 .2 %和 2 6 .7%。结扎切断脾血管 2 3例次 ,修补大血管 14例次。 4例次为意外紧急处理 ,其余均为预防性程序性处理 ;术后死亡 1例。血管修补组与同期血管壁残瘤组 2 8例比较 ,2年复发率分别为 14.3%和 5 3.6 % ,差异显著 ,P <0 .0 1。结论 对于累及腹腔大血管的原发性腹膜后巨大肿瘤 ,左侧大血管较易处理 ,手术切除率明显高于右侧 ;仔细结扎切断脾血管和预防性地切除受累大血管壁再行修补血管是保证手术安全性、提高腹膜后巨大肿瘤切除率、减少复发率的重要操作步骤。
Objective To retrospectively study the experience of surgical resection of primary retroperitoneal giant tumors in the past 15 years, and to summarize the effects of intraoperative arterial treatment methods and techniques on prognosis and postoperative complications. Methods The intraoperative treatment of 56 primary retroperitoneal giant tumors completely resected in the last 15 years was analyzed. The effect of tumor growth sites on the treatment of large abdominal vessels and the treatment of large vessels involved were summarized. Results The resection rates of primary retroperitoneal giant tumors involving left, middle, right and left and right abdomen were 87.5 %, 35.7%, 52. 2 % and 26 .7%, respectively. Ligation cut splenic blood vessels in 23 cases, and repair of large blood vessels in 14 cases. Four cases were accidental emergency treatment, and the rest were all preventive procedural treatments. One patient died after surgery. In the vascular repair group and the vascular wall residual tumor group, 28 cases had a recurrence rate of 14.3% and 53.6%, respectively, with a significant difference (P < 0.01). Conclusions For primary retroperitoneal giant tumors involving large celiac vessels, the left large vessels are easier to treat and the surgical resection rate is significantly higher than the right side; careful ligation of the splenic vessels and prophylactic resection of the affected large vessel wall to repair the vessel It is an important operation step to ensure the safety of surgery, increase the resection rate of retroperitoneal giant tumors, and reduce the recurrence rate.