中华肝脏外科手术学电子杂志
中華肝髒外科手術學電子雜誌
중화간장외과수술학전자잡지
CHINESE JOURNAL OF HEPATIC SURGERY(ELECTRONIC EDITION)
2014年
3期
161-164
,共4页
腔静脉,下%肾肿瘤%肾上腺肿瘤%腹膜后肿瘤%肿瘤细胞,循环%外科手术
腔靜脈,下%腎腫瘤%腎上腺腫瘤%腹膜後腫瘤%腫瘤細胞,循環%外科手術
강정맥,하%신종류%신상선종류%복막후종류%종류세포,순배%외과수술
Vena cava,inferior%Kidney neoplasms%Adrenal gland neoplasms%Retroperitoneal neoplasms%Neoplastic cells,circulating%Surgical procedures
目的：探讨累及下腔静脉的右上腹肿瘤患者外科手术治疗的安全性和疗效。方法回顾性分析2006年1月至2012年12月郑州大学第一附属医院肝胆胰外科收治的77例右上腹肿瘤患者临床资料。其中男36例，女41例；年龄22～71岁，中位年龄51岁；右肾癌20例，右肾错构瘤2例，右肾上腺肿瘤30例，腹膜后肿瘤25例。下腔静脉受侵犯55例，其中25例伴下腔静脉癌栓，包括Ⅰ型癌栓4例，Ⅱ型2例，Ⅲ型17例，Ⅳ型2例。所有患者均签署知情同意书，符合医学伦理学规定。行右上腹肋缘下切口或胸腹联合切口，游离、显露肿瘤及下腔静脉，术中根据情况阻断下腔静脉、肾静脉及第一肝门。对于Ⅰ、Ⅱ型癌栓，在切除肿瘤的同时取出癌栓。Ⅲ、Ⅳ型癌栓在体外循环辅助下先切除肿瘤再取出癌栓。观察患者围手术期情况，包括下腔静脉血流阻断时间、术中出血量、手术时间、术后住院时间，死亡和并发症发生等情况。结果77例患者均切除肿瘤及下腔静脉癌栓，手术顺利。下腔静脉血流阻断时间中位数为20（13～28）min，术中失血量800（200～1800）ml，手术时间156（120～180）min，术后住院时间15（10～18）d。围手术期死亡1例，死于窒息；围手术期无其他严重并发症发生。随访期间死亡10例，均死于肿瘤复发、转移。结论对于累及下腔静脉的右上腹肿瘤患者，选择合适的手术入路和方法行肿瘤及癌栓切除是安全、有效的。
目的：探討纍及下腔靜脈的右上腹腫瘤患者外科手術治療的安全性和療效。方法迴顧性分析2006年1月至2012年12月鄭州大學第一附屬醫院肝膽胰外科收治的77例右上腹腫瘤患者臨床資料。其中男36例，女41例；年齡22～71歲，中位年齡51歲；右腎癌20例，右腎錯構瘤2例，右腎上腺腫瘤30例，腹膜後腫瘤25例。下腔靜脈受侵犯55例，其中25例伴下腔靜脈癌栓，包括Ⅰ型癌栓4例，Ⅱ型2例，Ⅲ型17例，Ⅳ型2例。所有患者均籤署知情同意書，符閤醫學倫理學規定。行右上腹肋緣下切口或胸腹聯閤切口，遊離、顯露腫瘤及下腔靜脈，術中根據情況阻斷下腔靜脈、腎靜脈及第一肝門。對于Ⅰ、Ⅱ型癌栓，在切除腫瘤的同時取齣癌栓。Ⅲ、Ⅳ型癌栓在體外循環輔助下先切除腫瘤再取齣癌栓。觀察患者圍手術期情況，包括下腔靜脈血流阻斷時間、術中齣血量、手術時間、術後住院時間，死亡和併髮癥髮生等情況。結果77例患者均切除腫瘤及下腔靜脈癌栓，手術順利。下腔靜脈血流阻斷時間中位數為20（13～28）min，術中失血量800（200～1800）ml，手術時間156（120～180）min，術後住院時間15（10～18）d。圍手術期死亡1例，死于窒息；圍手術期無其他嚴重併髮癥髮生。隨訪期間死亡10例，均死于腫瘤複髮、轉移。結論對于纍及下腔靜脈的右上腹腫瘤患者，選擇閤適的手術入路和方法行腫瘤及癌栓切除是安全、有效的。
목적：탐토루급하강정맥적우상복종류환자외과수술치료적안전성화료효。방법회고성분석2006년1월지2012년12월정주대학제일부속의원간담이외과수치적77례우상복종류환자림상자료。기중남36례，녀41례；년령22～71세，중위년령51세；우신암20례，우신착구류2례，우신상선종류30례，복막후종류25례。하강정맥수침범55례，기중25례반하강정맥암전，포괄Ⅰ형암전4례，Ⅱ형2례，Ⅲ형17례，Ⅳ형2례。소유환자균첨서지정동의서，부합의학윤리학규정。행우상복륵연하절구혹흉복연합절구，유리、현로종류급하강정맥，술중근거정황조단하강정맥、신정맥급제일간문。대우Ⅰ、Ⅱ형암전，재절제종류적동시취출암전。Ⅲ、Ⅳ형암전재체외순배보조하선절제종류재취출암전。관찰환자위수술기정황，포괄하강정맥혈류조단시간、술중출혈량、수술시간、술후주원시간，사망화병발증발생등정황。결과77례환자균절제종류급하강정맥암전，수술순리。하강정맥혈류조단시간중위수위20（13～28）min，술중실혈량800（200～1800）ml，수술시간156（120～180）min，술후주원시간15（10～18）d。위수술기사망1례，사우질식；위수술기무기타엄중병발증발생。수방기간사망10례，균사우종류복발、전이。결론대우루급하강정맥적우상복종류환자，선택합괄적수술입로화방법행종류급암전절제시안전、유효적。
Objective To assess the safety and effects of surgical treatment for the right upper quadrant tumors with inferior vena cava involvement. Methods Clinical data of 77 patients with right upper quadrant tumors in Department of Hepatobiliary and Pancreatic Surgery, the First Afifliated Hospital of Zhengzhou University from January 2006 to December 2012 were analyzed retrospectively. There were 36 males and 41 females with age ranging from 22 to 71 years old and a median age of 51 years old. The patients included 20 cases of right renal carcinoma, 2 cases of hamartoma of right kidney, 30 cases of right adrenal tumors, 25 cases of retroperitoneal tumors. Inferior vena cava involvement was observed in 55 cases, in which 25 cases were combined with tumor thrombus of inferior vena cava. Four cases were tumor thrombus typeⅠ, 2 cases were typeⅡ, 17 cases were typeⅢ, and 2 cases were typeⅣ. The informed consents of all patients were obtained and the ethical committee approval was received. Subcostal incisions in the right upper abdomen or thoracoabdominal incisions were made and the tumors and inferior vena cava were separated and exposed. The blood lfows of inferior vena cava, renal veins and the ifrst porta were excluded depending on circumstances during the operation. For tumor thrombus typeⅠandⅡ, it was removed at the same time as the tumors were resected. For tumor thrombus typeⅢandⅣ, it was removed after the tumors were resected under cardiopulmonary bypass. The perioperative situations of patients including duration of inferior vena cava blood exclusion, intraoperative blood loss, operation duration, postoperative hospital stay, death and complications were observed. Results All the 77 cases underwent tumor resection and removal of tumor thrombus of inferior vena cava successfully. The median of duration of inferior vena cava blood exclusion was 20 (13-28)min. The intraoperative blood loss was 800(200-1 800)ml. The operation duration was 156 (120-180)min. The postoperative hospital stay was 15(10-18)d. One case died of asphyxia during the perioperative period. No other severe complication was observed during the perioperative period. Ten cases died of tumor recurrence and metastasis during the follow up. Conclusion For the patients with right upper quadrant tumors with inferior vena cava involvement, resecting the tumor and tumor thrombus is safe and effective by choosing a proper surgical approach.
