摘要
目的探讨腔静脉内肿瘤的诊断和手术治疗。方法回顾性研究近年来收治的6例腔静脉内肿瘤患者的临床资料，包括患者首发症状、主要临床表现、手术治疗过程和预后，对比研究B超、CTA、MRA等诊断方法。结果6例患者术前均行B超检查；2例经CTA、4例经MRA确诊；累及心脏3例。均采取手术治疗，根据肿瘤生长范围，3例采取胸腹联合切口，于心包外阻断下腔静脉；3例体外循环下腹部正中切口和一中开胸切口，打开右心房；所有病例的肿瘤均完整切除且发现双瘤体1例。病理报告平滑肌瘤4例，平滑肌肉瘤2例。1例平滑肌肉瘤患者因术后肝功能衰竭死亡，其余术后均恢复良妤。平均随访51个月未发现复发。结论B超、CTA、MRA对腔静脉内肿瘤均有诊断价值，MRA能提供多方位更清晰的解剖关系，有助于手术方法的选择。外科手术是腔静脉内朋，瘤主要治疗方法，术中应探查腔静脉及髂总静脉的主要属支，盆腔来源肿瘤可以结扎髂内静脉，以预防复发。
Objective To investigate the diagnosis and surgical treatment of intracaval venous tumors. Methods Clinical data of 6 cases were retrospectively analyzed, including signs and symptoms diagnostic means such as type-B ultrasound, CTA, MRA, surgical procedures and prognosis. Results All six cases received type-B ultrasonic examination, final definite diagnosis was achieved by CTA exam in 2 cases and through MRA in 4 cases. Heart involvement was found in 3 cases. All patients underwent a surgery. According to the extent of the tumor, 3 cases had thoraco-abdominal incision, 3 cases with extracorporeal circulation and right atrium opening. All of the tumors were completely resected. Pathological exam revealed that 4 cases were of leiomyomatosis and 2 cases were of leiomyosarcoma. One case with leiomyosarcoma died of liver disfunction postoperatively. The other 5 cases recovered without major complications. An average 51 months of follow-up found no recurrence. Conclusions CT and MRI are the mainstay for the diagnosis, and MRI can provide clear anatomy image to the surgeons, help choose the surgical procedures. The one-stage operation is effective. During the operation, the main branches of the vena cava system should be detected, and the attachment of the tumor should be found and removed thoroughly to prevent the recurrence of the tumor. When the attachment point is lower than the lilac vein level, ligation of the involved lilac vein should be mandatory.
出处
《中华普通外科杂志》
CSCD
北大核心
2008年第8期578-580,共3页
Chinese Journal of General Surgery
关键词
平滑肌痛
平滑肌肉瘤
腔静脉
诊断
外科手术
Leiomyoma
Leiomyosarcoma
Venae cavae
Diagnosis
Surgical procedures, operative
