再次或多次手术治疗复发性腹膜后 脂肪肉瘤的临床意义

Clinical significance of reoperation and multiple operations in recurrent retroperitoneal liposarcoma

摘要:

目的 探讨再次手术或多次手术治疗复发性腹膜后脂肪肉瘤的治疗策略和临床意义。方法 回 顾性分析2013 年1 月—2017 年8 月北京大学第一医院普通外科收治的16 例腹膜后脂肪肉瘤术后复发患者（复 发组）行再次或多次手术的临床资料，随访时间12 ～ 62 个月，平均30 个月；观察其术后效果。结果 16 例 腹膜后肿瘤术后复发患者共行手术30 例次，手术时间60 ～ 840 min，平均360 min ；中位手术时间270 min， 术中出血50 ～ 33 100 ml，平均3 755 ml ；中位出血量800 ml。其中，28 例次手术为联合脏器切除。原发性腹 膜后脂肪肉瘤行手术治疗患者（原发组）与复发组在肿瘤最大径、是否多灶等指标比较，差异无统计学意义 （P >0.05），而手术时间、出血量及是否联合脏器切除比较，差异有统计学意义（P <0.05）。随访期间无瘤存 活率为25%（4/16），带瘤生存8 例，死亡4 例。结论 对于复发性腹膜后脂肪肉瘤患者，经多学科评估和完 善的术前准备，可行再次或多次手术治疗。

Abstract:

Objective To investigate treatment strategy and clinical significance of re-surgery and multiple times surgery in recurrent retroperitoneal liposarcoma. Methods A total 16 cases of recurrent retroperitoneal liposarcoma performed with several times re-operations from January 2013 to August 2017 in department of general surgery, Peking University First Hospital were analyzed retrospectively. All patients were followed for 30 months averagely (12~62 months). Results All 16 cases of recurrent retroperitoneal liposarcoma were undergone 30 operations. Operations lasted for 360 (60~840) min in average, and the median operation time was 270min; the average blood loss was 3755 (50~33 100) ml, and the median blood loss was 800ml. Combined adjacent organs were systematically resected in 28 operations. Comparing with primary retroperitoneal liposarcoma, the recurrent cases had no statistical difference in the maximum diameter of tumor and multi focal lesions (P > 0.05). However, the recurrent cases group had longer operation time, more intraoperative bleeding and higher combined organ resection rate significantly than primary group (P < 0.05). 4 patients were alive without recurrence, 8 patients were alive with recurrence, and 4 patients died during follow-up. Conclusions Reoperations and multiple operations could be feasible on recurrent retroperitoneal liposarcoma with multidisciplinary evaluation and optimized preoperative preparation.