中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2012年
2期
103-105
,共3页
梅建民%于聪慧%聂洪峰%王剑飞%孙泊洋
梅建民%于聰慧%聶洪峰%王劍飛%孫泊洋
매건민%우총혜%섭홍봉%왕검비%손박양
右上腹部%非肝源性巨大肿瘤%影像学检查%误诊%外科手术
右上腹部%非肝源性巨大腫瘤%影像學檢查%誤診%外科手術
우상복부%비간원성거대종류%영상학검사%오진%외과수술
Right upper quadrant abdomen%Huge non-hepatic tumor%Imaging examination%Misdiagnosis%Surgical resection
目的 探讨右上腹非肝源性巨大肿瘤的诊治.方法 回顾分析我院2004年5月至2009年12月收治的9例右上腹非肝源性巨大肿瘤患者的临床资料.结果 9例中7例术前影像学诊断未能区分肿瘤为非肝源性,2例术中不能除外肿瘤是否来源于肝脏.9例肿瘤均手术切除,其中联合半胃切除1例,肝下下腔静脉侧壁部分切除2例,右肾脂肪囊完全切除2例,胰十二指肠、横结肠切除1例,胰体尾胰管切断后胰肠吻合1例.手术历时318～660 min,中位时间390 min.术中失血量400～6000ml,中位失血量2560m1；术中输血量0～5250ml,中位输血量2450 ml.切除肿瘤直径11～30 cm,平均为14.5 cm;切除肿瘤重量960～5100 g,平均为2465 g.恶性肿瘤8例,恶性潜能未定肿瘤1例(胰腺实性假乳头状瘤).术后胰漏1例,无严重并发症和手术死亡.术后5个月复发1例.术后1年存活率100％,2年存活率56％,3年存活率33％.1例患者存活已超过5年.结论 右上腹非肝源性巨大肿瘤与肝脏关系密切,易被误诊为巨大肝脏肿瘤.应仔细分析其影像学特征,正确区分肿瘤是否为非肝源性并予积极手术治疗.此类肿瘤手术切除率高,治疗效果令人满意.
目的 探討右上腹非肝源性巨大腫瘤的診治.方法 迴顧分析我院2004年5月至2009年12月收治的9例右上腹非肝源性巨大腫瘤患者的臨床資料.結果 9例中7例術前影像學診斷未能區分腫瘤為非肝源性,2例術中不能除外腫瘤是否來源于肝髒.9例腫瘤均手術切除,其中聯閤半胃切除1例,肝下下腔靜脈側壁部分切除2例,右腎脂肪囊完全切除2例,胰十二指腸、橫結腸切除1例,胰體尾胰管切斷後胰腸吻閤1例.手術歷時318～660 min,中位時間390 min.術中失血量400～6000ml,中位失血量2560m1；術中輸血量0～5250ml,中位輸血量2450 ml.切除腫瘤直徑11～30 cm,平均為14.5 cm;切除腫瘤重量960～5100 g,平均為2465 g.噁性腫瘤8例,噁性潛能未定腫瘤1例(胰腺實性假乳頭狀瘤).術後胰漏1例,無嚴重併髮癥和手術死亡.術後5箇月複髮1例.術後1年存活率100％,2年存活率56％,3年存活率33％.1例患者存活已超過5年.結論 右上腹非肝源性巨大腫瘤與肝髒關繫密切,易被誤診為巨大肝髒腫瘤.應仔細分析其影像學特徵,正確區分腫瘤是否為非肝源性併予積極手術治療.此類腫瘤手術切除率高,治療效果令人滿意.
목적 탐토우상복비간원성거대종류적진치.방법 회고분석아원2004년5월지2009년12월수치적9례우상복비간원성거대종류환자적림상자료.결과 9례중7례술전영상학진단미능구분종류위비간원성,2례술중불능제외종류시부래원우간장.9례종류균수술절제,기중연합반위절제1례,간하하강정맥측벽부분절제2례,우신지방낭완전절제2례,이십이지장、횡결장절제1례,이체미이관절단후이장문합1례.수술력시318～660 min,중위시간390 min.술중실혈량400～6000ml,중위실혈량2560m1；술중수혈량0～5250ml,중위수혈량2450 ml.절제종류직경11～30 cm,평균위14.5 cm;절제종류중량960～5100 g,평균위2465 g.악성종류8례,악성잠능미정종류1례(이선실성가유두상류).술후이루1례,무엄중병발증화수술사망.술후5개월복발1례.술후1년존활솔100％,2년존활솔56％,3년존활솔33％.1례환자존활이초과5년.결론 우상복비간원성거대종류여간장관계밀절,역피오진위거대간장종류.응자세분석기영상학특정,정학구분종류시부위비간원성병여적겁수술치료.차류종류수술절제솔고,치료효과령인만의.
Objective To study the pathology and treatment of huge nonhepatic tumors in the right upper quadrant of abdomen.Methods The clinical data of 9 patients with huge nonhepatic tumor in the right upper quadrant of abdomen treated surgically at our hospital from May 2004 to December 2009 were retrospectively analyzed.Results Preoperative imaging failed to define the tumors as nonhepatic in original in 7 patients and operation failed to recognize the origin of the tumors in 2 patients.All the tumors were successfully resected,with combined hemigastectomy in 1 patient,partial resection of the lateral wall of the infrahepatic vena cava in 2,complete resection of adipose capsule of the right kidney in 2,pancreatoduodenectomy plus transverse colectomy in 1,and transection of pancreatic duct of the body and tail of the pancreas and pancreaticojejunostomy in 1.The median operation time was 390 min (318-660 min).The median intraoperative blood loss was 2560 ml (400-6000 ml).The median intraoperative blood transfusion was 2450 ml (0 -5250 ml).The average diameter of the resected tumor was 14.5 cm (11-30 cm),and the average tumor weight was 2465 g (960-5100 g).Postoperative pathological diagnoses showed that 8 patients had malignant tumors and 1 had a potentially malignant and undifferentiated tumor (solid pseudopapillary tumor of pancreas).Perioperative pancreatic anastomotic leak occurred in 1 patient,and there were no severe postoperative complications and operative death in this series.Tumor recurrence was detected 5 months following operation in 1 patient.The 1,2-,3-year survival rates were 100％,56％,33％,respectively.One patient survived for more than 5 years.Conclusions Huge non-hepatic tumors in the right upper quadrant of abdomen could easily be misdiagnosed as hepatic neoplasms.The surgical resection rate was high.The prognosis for patients who received resectional treatment was satisfactory.
