【摘要】 目的 探讨外科手术治疗原发性腹膜后肿瘤的方法和影响患者预后的因素。 方法 回顾分析2002年5月-2008年5月收治的70例原发性腹膜后肿瘤患者的临床表现、影像学检查、手术治疗及随访情况。 结果 70例患者均进行了手术治疗，其中良性肿瘤20例（28.57%），恶性肿瘤50例（72.43%），良恶之比为1∶2.5；完整切除肿瘤者58例（82.86%），肿瘤部分切除者7例（10%），肿瘤广泛转移行组织活检者5例（7.14%），联合器官切除者18例（25.71%）。术后随访1~5年恶性肿瘤患者45例，其中肿瘤完全切除组1、3、5年的生存率分别为91.67%、66.67%、22.22%，肿瘤部分切除组分别为66.67%、33.33%、0%。两组比较差异有统计学（Plt;0.01）。研究发现肿瘤的大小、病理类型、是否完整切除是影响肿瘤局部复发、患者生存率的重要因素。 结论 早期诊断、充分的术前准备、肿瘤的全切除率能显著改善患者术后远期生存率。【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.
ObjectiveTo evaluate efficacy and safety of laparoscopic Glissonean pedicle transection anatomic hepatectomy using indocyanine green (ICG) fluorescence imaging.MethodThe retrospective analysis was made on the preoperative clinical data, surgical treatment and postoperative status of a patient with hepatocellular carcinoma who underwent the laparoscopic Glissonean pedicle transection anatomic hepatectomy using the ICG fluorescence imaging technology in the Department of Liver Surgery, West China Hospital of Sichuan University.ResultsAccording to the preoperative history, imaging and laboratory examinations, the diagnosis of hepatocellular carcinoma was considered. The intraoperative exploration revealed that there was only one tumor located in the segment Ⅳ and was superficial. The ICG fluorescence imaging was used to perform the Glissonean pedicle transection anatomic hepatectomy. The postoperative pathological diagnosis was consistent with hepatocellular carcinoma without serious complications. The patient recovered well. No recurrence was found in the follow-up period up to 6 months.ConclusionsLaparoscopic Glissonean pedicle transection anatomic hepatectomy using ICG fluorescence technology can be used as a safe and precise treatment to solve problems such as bleeding during operation, difficult determination of tumor boundary, and whether having residual tumor in surgical margin.
ObjectiveTo explore the safety and feasibility of contrast enhanced intraoperative ultrasonographyguided percutaneous radiofrequency ablation with artificial hydrothorax to hepatocellular carcinoma in the hepatic dome. MethodsThe clinical data of nine patients with hepatocellular carcinoma in the hepatic dome underwent ultrasonographyguided percutaneous radiofrequnecy ablation with artificial hydrothorax from January 2008 to June 2009 at Department of Hepatobiliopancreatic Surgery of West China Hospital were retrospectively analyzed. The perioperative results and recurrence of tumor were also analyzed. ResultsAll of nine patients with twelve tumors received successfully radiofrequency ablation with artificial hydrothorax of (2 444±464) ml (2 000-3 000 ml). The ablation time was 12-24 min (median 12 min), with an average of (15±5) min for each tumor. No hemothorax, pneumothorax, and death occurred during operation. One patient had ascites of 2 000 ml after ablation due to hypoalbuminenia, and ascites disappeared by infusion of abumin on 4 d after operation. The total volume of pleural drainage was 250-1 420 ml, with an average of (717±372) ml for each patient, and the drainage tube was withdrawn on 3-5 d after operation. The followup time was 7-23 months (mean 15 months). Tumor recurrence was found in three patients on 5, 6, and 7 months after operation, respectively. Of them, two patients were in stable disease stage after interventional and conservative therapy, respectively, and one case recurred at six months after operation and died of hypertensive heart disease and hepatic function deterioration at sixteen months after operation. The rest patients survived and no recurrence and metastasis was observed during the follow-up period.ConclusionThe technique of percutaneous radiofrequency ablation with artificial hydrothorax increases the feasibility of the minimal invasive treatment for hepatoma, which can be applied to hepatocellular carcinoma in the hepatic dome with high safety and clinical application value.
ObjectiveTo summarize the treatment of a patient with congenital portosystemic shunt (CPS) complicated with hepatic focal nodular hyperplasia (FNH), and to explore the feasibility and safety of combined laparoscopy and interventional radiology therapy at the same time.MethodsThe clinicopathological data of a patient with CPS complicated with hepatic FNH who admitted to West China Hospital of Sichuan University in March 2019 was retrospectively analyzed.ResultsThe patient underwent laparoscopic liver nodule resection and digital subtraction angiography (DSA) guided jugular portal portosystemic shunt fistula embolization. The laparoscopic surgery operation time was 180 min and the intraoperative blood loss was 50 mL, and for interventional procedure was 230 min and 10 mL respectively. There were no complications after operation and the patient was successfully discharged on the 8th day after surgery. The patient was followed up for six months and in good condition.ConclusionsCPS patient should develop individualized treatment under the discussion of multidisciplinary cooperation group. The combination of laparoscopy and interventional technique can be minimally invasive and efficient to solve portal vein-avitary shunt fistula and benign hepatic nodules at the same time.
ObjectiveTo evaluate and discuss the various surgical methods for hepatic echinococcosis. MethodsFour hundred and two patients with hepatic echinococcosis were treated in West China Hospital of Sichuan University from 2009 to 2014 and 271 of them were undergone surgical treatment. The cystic echinococcosis was in 195 patients, including 80 cases performed classic endocystectomy or subtotal cystectomy, 109 performed total cystectomy or hepatectomy, 6 cases performed palliative surgery. The alveolar echinococcosis was in 76 patients, including 7 cases performed palliative surgery, 54 cases performed hepatectomy, 12 cases performed liver allotransplantation, and 3 cases performed liver autotransplantation. Results①The draining time, the rate of postoperative complications, and the recurrence was (18.6±2.7) d, 21.2% (17/80), and 15.0%(12/80) respectively in the cases of cystic echinococcosis underwent classic endocystectomy or subtotal cystectomy, which were significantly higher than those cases of cystic echinococcosis underwent total cystectomy or hepatectomy〔(5.4±0.6) d, 7.3% (8/109), and 0.9% (1/109), respectively, P < 0.05〕.②The draining time and the recurrence was (5.9±0.7) d and 1.8% (1/54) respectively in the cases of alveolar echinococcosis underwent hepatectomy, which were significantly lower than those in the cases of alveolar echinococcosis took palliative surgery〔(9.7±1.4) d and 57.1% (4/7), respectively, P < 0.01〕. The 12 patients underwent liver transplantation were complete rehabilitation, while the rest 3 were death. Conclusions①Total cystectomy or hepatectomy should be the first choice for cystic echinococcosis; Palliative treatment could improve the symptoms of unresectable patients with cystic echinococcosis.②Hepatectomy should be the first choice for alveolar echinococcosis, palliative surgery could only be used to alleviate symptoms and physical signs, delay the progression of this disease.③Liver transplantation might be an alternative for advanced hepatic echinococcosis.
ObjectiveTo discuss various surgical methods for hepatic alveolar echinococcosis. MethodsThe clinical data of 98 patients with hepatic alveolar echinococcosis treated in West China Hospital of Sichuan University from 2004 to 2015 were analyzed retrospectively. Palliative surgeries were performed in 9 cases, radical hepatectomies were performed in 69 cases, liver transplantations were performed in 20 cases, in which 12 cases were performed by liver allotransplantation, and 8 cases were performed by liver autotransplantation. ResultsThere was no death case during perioperative period. The rate of postoperative complications of the radical hepatectomy (11.6%, 8/69) was significantly lower than that of the palliative surgery (44.4%, 4/9), which had statistically significant difference (P<0.05). The followup time was from 4 months to 6 years, the average time was 36 months. The postoperative recurrence rate in the radical hepatectomy (1.4%, 1/69) was significantly lower than that in the palliative surgery (55.6%, 5/9), which had statistically significant difference (P<0.05). During follow-up period, the mortality of the palliative surgery (33.33%, 3/9) was also significantly higher than that of the radical hepatectomy (0, 0/69), which had statistically significant difference (P<0.05). Four patients underwent liver transplantation were death within 3 months (20.0%). ConclusionsRadical hepatectomy should be the first choice for alveolar echinococcosis. In this research, although the rates of postoperative complications and recurrence in palliative surgery are higher than those in radical hepatectomy, palliative surgery, for the patients who had lose the opportunity to perform radical hepatectomy, could be used to alleviate symptoms and physical signs, improve quality of life, delay progression of this disease. Although risk of liver transplantation is high, this might be an alternative for advanced hepatic alveolar echinococcosis.
Objective To discuss the clinical application of two-stage hepatectomy for multiple and huge hepatic alveolar echinococcosis. Methods The clinical data of 7 patients with multiple hepatic alveolar echinococcosis treated with two-staged hepatectomy in West China Hospital of Sichuan University and The people's Hospital of Ganzi Tibetan Autonomous Prefecture of Sichuan Province from August, 2013 to June, 2016 were analyzed retrospectively. The preoperative diagnose was definite according to CT and (or) MRI, serological and life in the epidemic area. The patients, which the future liver remnant was less than 30% according to CT, received two-staged hepatectomy. Epigastric enhancement CT, liver function and blood routine examination were reviewed monthly after the first surgery, the second surgery was operated after 3 monthes, epigastric ultrasound, enhancement CT or MRI, liver function, blood routine examination and serological were adopted in 1, 6, and 12 months and each year after the second operation. Results The liver function was normal in 7 days after two operations and no complications after the first suegery, one patient developd with biliary fistula after the second surgery, no recurrence or death occurred during the followed-up period. Conclusion The two-stage hepatectomy can be operated in multiple and huge alveolar echinococcosis to reduce surgery risk and cost, shorten hospital stays and improve quality of life.