中国实用外科杂志

中国实用外科杂志

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腹膜后肉瘤术中结扎受累髂外动脉可行性探讨（附3例报告）

郑嘉佳a，杨    珏b，童汉兴a，陆维祺a   

  1. 复旦大学附属中山医院 a.普外科 b.血管外科，上海 200032
  • 出版日期:2017-10-01 发布日期:2017-10-11

  • Online:2017-10-01 Published:2017-10-11

摘要：

目的    探讨腹膜后肿瘤切除术中对受累髂外动脉的处理策略。方法    回顾性分析2012年11月至2014年11月复旦大学附属中山医院普外科收治的3例腹膜后肉瘤侵犯髂外动脉病例资料。1例术中即发现髂外动脉闭塞，2例血管重建后因吻合口破裂出血，急诊手术。3例均行一侧髂外动脉结扎术。结果    术后病理学检查示，3例病人肿瘤均侵犯血管旁脂肪组织，其中1例病人血管闭锁，管腔内为血栓机化物。1例术后出现小腿疼痛症状，经扩血管药物治疗1个月后，症状好转；另2例病人术后无下肢缺血症状，未出现下肢跛行，并均于术后2周行CT血管造影（CTA）检查，可见左髂外动脉中断，但股动脉及以下血流正常，其中1例病人动脉中断处周围有较多侧支血管显影。术后随访6个月，3例病人下肢血供均无异常，活动未受影响。结论    腹膜后肉瘤侵犯髂外动脉时，如下肢动脉已建立侧支循环，在被动情况下，可选择直接结扎髂外动脉。

关键词: 腹膜后肉瘤, 髂外动脉, 结扎, 重建

Abstract:

Without restruction followed the external iliac artery resection for en bloc excision of huge retroperitoneal sarcoma: A report of three cases        ZHENG Jia-jia*，YANG Yu，TONG Han-xing，et al. *Department of General Surgery，Zhongshan Hospital, Fudan University，Shanghai 200032，China
Corresponding author：LU Wei-qi，E-mail:  lu.weiqi@zs-hospital.sh.cn
Abstract    Objective    To discuss the experience of dealing with external iliac artery which involved by retroperitoneal sarcoma. Methods    The clinical data of 3 patients treated in Department of General Surgery，Zhongshan Hospital, Fudan University from November 2012 to November 2014 were analyzed retrospectively. The patients underwent en bloc excision of retroperitoneal sarcoma involved external iliac artery. One patient was found external iliac arterial occlusion during the operation. Two patients underwent emergency operations because of rupture of arterial anastomoses after vascular reconstruction in previous operations. All patients ligated unilateral external iliac arteries finally. Results Postoperative pathological examinations showed that, in all three patients, tumors invaded adipose tissue lateral to the arteries, and one of the three had vascular atresia by thrombus. One patient had calf muscle pain after operation, and was cured by vasodilator drugs 1 months later. Another two patients had no symptoms of lower limb ischemia or claudication.Two weeks after operations, CTA were conducted in both patients, and showed discontinuities of left external iliac arteries, but the blood flows in femoral arteries and their distal branches were normal. Many collateral vessels could be seen around the artery interruption. Follow-up of 6 months after operations showed that there was no influence in blood supplies of the lower limbs among all three patients. Conclusion    It is generally agreed that the risk of artery ligation is high. But in certain conditions，collateral circulation may avoid those disastrous consequences.

Key words: retroperitoneal sarcoma, external iliac artery, ligation, remodeling