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两种腹膜后腔建立方法的比较

【摘要】 目的 比较气囊法组和直接法组建立腹膜后腔的临床价值。 方法 对2005年5月-2008年12月32例后腹腔镜手术建立腹膜后腔的临床资料进行比较，统计分析两种腹膜后腔建立方法在时间、空间大小、食指经穿刺孔能否触及肾脏、并发症发生率、出血量等的差别。 结果 两种方法均成功建立腹膜后腔。气囊法组建立腹膜后腔时间平均为（13.17±1.40） min，直接法组为（4.45±1.20） min。气囊法组腹膜后腔空间为（396.00±13.33） mL，直接法组为（85.50±6.05） mL。气囊法组食指经穿刺孔能触及肾脏6例（50%），直接法组无1例（0%）。组间比较，差异有统计学意义（Plt;0.01）。两组患者建立空间后经观察均为少量渗血，气囊法组发生气囊爆裂1例。 结论 直接法组在时间上明显优于气囊法组，与气囊法组比较并未增加相关并发症，但建立的空间较小；在熟练掌握了气囊法组后可以运用直接法组建立腹膜后腔。

Treatment and Prognosis of Primary Retroperitoneal Tumor

【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.

腹膜后巨大淋巴管瘤合并肝脓肿1例报道

Retroperitoneal Schwannoma with Gastric Schwannoma: A Case Report and Review of the Literature

目的　总结1例腹膜后神经鞘瘤合并胃神经鞘瘤的临床诊疗方法。 方法　2010年12月收治1例女性患者，因呕血行CT检查发现胃体前壁及右肾上腺区占位入院，行胃楔形切除术及右肾上腺肿瘤切除术治疗。 结果　术后病理证实为腹膜后神经鞘瘤合并胃神经鞘瘤，随访半年无复发。 结论　腹膜后神经鞘瘤合并胃神经鞘瘤病例罕见且诊断困难，影像学检查缺乏特异性，可依靠术后病理检查确诊；外科手术完整切除肿瘤是有效的治疗方法，预后较好。

Use Microwave Coagulation to Treat Bleeding During Resection of Retroperitoneal Tumor (Report of 9 Cases)

目的 探讨微波固化在腹膜后肿瘤手术中止血的可行性。方法 对我院2008年7月至2009年8月期间收治的9例腹膜后肿瘤患者手术中应用微波固化止血。手术暴露瘤体后，应用微波治疗仪多点固化瘤体。手术切除肿瘤，不能完整切除者则再次应用微波治疗仪固化瘤床创面，尽量灭活残余肿瘤。结果 9例患者肿瘤切除后创面几乎无渗血，术中失血量（275.56±81.26） ml，手术时间（150.56±36.18） min，住院时间（14.67±2.30） d，无术后并发症发生。术后随访（10±3.97)个月，9例患者均未见复发。结论 腹膜后肿瘤手术过程中应用微波固化止血效果良好。

RETROPERITONEAL LAPAROSCOPIC APPROACH COMBINED WITH ANTEROLATERAL MINI-INCISION FOR LUMBAR SPINE TUBERCULOSIS

ObjectiveTo investigate the effectiveness of retroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis. MethodsA retrospective analysis was made on the cl inical data of 22 patients with lumbar spine tuberculosis undergoing focus clearance, fusion, and internal fixation by retroperitoneal laparoscopic approach combined with anterolateral mini-incision between June 2006 and June 2012. There were 14 males and 8 females, with an average age of 42.6 years (range, 26-57 years) and with a mean disease duration of 7.3 months (range, 3-10 months). There were 17 patients with single-level spinal tuberculosis (L1, 2 in 3, L2, 3 in 6, L3, 4 in 4, L4, 5 in 2, and L5 in 2) and 5 patients with double-level spinal tuberculosis (L1-3 in 2 and L2-4 in 3). The preoperative Cobb's angle of lumbar spine was 5-28° (mean, 20°). In 6 patients having compression symptom, 4 cases were rated as grade D and 2 as grade C according to Frankel classification. The operative time, intraoperative blood loss, and postoperative complications were recorded. At last follow-up, the neurologic function was assessed according to Frankel grade, the Cobb's angle after operation was measured on lumbar lateral X-ray film; the efficacy was evaluated according to Nakai criteria, and the fusion was evaluated according to Suk criteria. ResultsAll operations were successfully completed. The operation time was 110-250 minutes (mean, 140 minutes), and intraoperative blood loss was 120-280 mL (mean, 180 mL). The symptoms of femoral nerve injury and sympathetic nerve injury occurred in 1 case respectively and was relieved at 1-3 weeks after operation. All incisions healed by first intention. The patients were followed up 16-50 months (mean, 21 months). During the follow-up period, no loosening or breakage of implants and no tuberculosis recurrence were found. At last follow-up, the nerve function was recovered to grade E in the others except 1 case at grade D. The Cobb's angle was 2-16° (mean, 7.8°). According to Nakai criteria for efficacy evaluation, the results were excellent in 9 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 86.4%. The bony fusion rate was 95.5% (21/22) according to Suk criteria. ConclusionRetroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis is a safe and effective approach with minimal invasion and less complications.

Analysis of Multi-Detector-Row Spiral CT Signs in Inflammatory Diseases in Retroperitoneal Space

【Abstract】ObjectiveBy using multidetectorrow spiral CT (MDCT), to investigate the CT imaging features of inflammatory diseases in retroperitoneal space with correlation of radiological anatomy.MethodsThe clinical and laboratory dada of 30 patients with proven inflammatory diseases of retroperitoneal space were collected. All patients underwent MDCT plain scanning and portal venous acquisition. CT imaging data generated at portal venous phase were processed with coronal, sagittal and oblique multiplanar reformation (MPR) technique.ResultsAcute pancreatitis and various types of renal infection were the two main sources of retroperitoneal inflammation. Depending on the specific anatomic locations, retroperitoneal inflammation of different subspaces demonstrated characteristic imaging features. Spreading of inflammatory process across subspaces was also quite common.ConclusionMDCT is the imaging method of choice to depict comprehensively and clearly the inflammatory diseases of various retroperitoneal spaces.

Application of orthotopic autologous renal transplantation combined with inferior vena cava resection and reconstruction in retroperitoneal tumor

Objective To investigate the application and clinical efficacy of orthotopic autologous renal transplantation combined with inferior vena cava (IVC) resection and reconstruction in retroperitoneal tumor. Methods The clinical data of a patient with complex retroperitoneal tumor was analyzed retrospectively. Abdominal CT examination showed that the tumor originated from IVC and invaded the retrohepatic IVC and bilateral renal vein trunks. Intraoperative ultrasound exploration revealed mechanized thrombosis in the IVC and bilateral renal vein trunks. After blocking the left renal vein, no significant hemodynamic changes were seen before and after intraoperative ultrasound exploration and contrast-enhanced ultrasound. Results After complete removal of the left renal vein and suture of the severed end, the right renal vein was successfully reconstructed with an orthotopic autologous right kidney graft combined with IVC resection after removal of the mechanized thrombus. The patient recovered well after surgery, and a repeat CT showed that the reconstructed artificial IVC was patent, and the color Doppler ultrasonography of both kidneys showed good perfusion and no obstruction of return. The patient was given oral rivaroxaban anticoagulant therapy after operation, and discharged at 19 days after operation. The postoperative pathological findings suggested inferior vena cava smooth muscle sarcoma. Conclusion Orthotopic autologous renal transplantation combined with IVC resection and reconstruction for complex retroperitoneal tumor is safe and feasible, and the left renal vein can be ligated and dissected intraoperatively, but a comprehensive evaluation with intraoperative ultrasound (imaging) is required.

Efficacy of High-dose Three-dimensional Conformal Radiotherapy Combined with Surgery on Primary Retroperitoneal Soft Tissue Sarcoma

【摘要】　目的　评价大分割适形放射治疗对腹膜后软组织肿瘤术后患者的治疗作用。　方法　对1998年10月-2003年4月收治的16例腹膜后软组织急性肿瘤术后患者行大分割适形放射治疗，设计临床靶区等效生物剂量为55～62 Gy，观察放疗后2、5年局部控制率、生存率和无病生存情况。　结果　2、5年局部控制率较未行放疗患者明显提高并和其他放射治疗方式达到较高治疗剂量者近似；远期生存无改善，无病生存率较未行放疗患者有提高。　结论　大分割适形放射治疗方式对腹膜后软组织急性肿瘤术后患者有较好的局部控制作用，无瘤生存率有提高，远期生存无改善，无严重的远期放疗后遗症。【Abstract】　Objective　To observe the effect of high-dose three-dimensional conformal radiotherapy combined with surgery on primary retroperitoneal soft tissue sarcoma.　Methods　A total of 16 patients with primary retroperitoneal soft tissue sarcoma underwent high-dose three-dimensional conformal radiotherapy after sarcoma excision from October 1998 to April 2003. The biologically effective dose was 55-62 Gy for CTV. The local control rate and long-term survival rate and disease free survival after 2 and 5 years were observed.　Results　The local control rate obviously raised in these patients after 2 and 5 years; but the long-term survival rate didn’t improve and the disease free survival improved in these patients compared with those wasn’t radiated.　Conclusion　High-dose three-dinensional comfomal radiotherapy is effective on the patients with retroperitoneal soft tissue sarcoma in local control rate and disease free survival, but long-term survival rate is not improved and the side-effect is not serious.

腹腔镜与开腹手术治疗腹膜后位阑尾炎的临床疗效比较

目的 比较腹腔镜阑尾切除术（laparoscopic appendectomy，LA）与开腹阑尾切除术（open appendectomy，OA）在腹膜后位阑尾炎治疗中的临床效果。 方法 回顾性分析 2012 年 1 月至 2016 年 12 月期间于笔者所在医院科室接受 LA 或 OA 的 147 例腹膜后位阑尾炎患者的临床资料，比较 LA 和 OA 的临床疗效。 结果 所有病例均未死亡、临床治愈。2 组患者的手术时间和住院费用比较差异均无统计学意义（P>0.05），但 LA 组的肠功能恢复时间、止痛药物使用率、术后感染率及住院时间均低于（短于）OA 组，差异均有统计学意义（P<0.05）。 结论 对于无腹腔镜手术禁忌的腹膜后位阑尾炎患者，LA 较 OA 具有术后疼痛轻、恢复快、并发症少及住院时间短的优点。