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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.

腹膜后巨大淋巴管瘤合并肝膿腫1例報道

Predictive factors for recurrence of retroperitoneal sarcoma

ObjectiveTo summarize the predictive factors of recurrence of retroperitoneal sarcoma.MethodsThe literatures on the recurrence of retroperitoneal sarcoma at home and abroad were reviewed and analyzed.ResultsTumor size, margin negative resection, tumor grade, multifocal, and histological types were important predictors of the recurrence of retroperitoneal sarcoma. In addition, combined organ resection, diversity of tumor growth patterns, and tumor-free surgical techniques could also affect the recurrence of retroperitoneal sarcoma.ConclusionUnderstanding the predictive factors of the recurrence of retroperitoneal sarcoma is of great significance to guide surgeons to understand and recognize the disease, to reduce the recurrence of retroperitoneal sarcoma.

Pathogenesis and comprehensive treatment of primary retroperitoneal liposarcoma

ObjectiveTo understand the pathogenesis and the research progress of comprehensive treatment of primary retroperitoneal liposarcoma (PRLPS) and to provide evidence for clinical diagnosis and treatment.MethodThe recent literatures on the pathological classification, pathogenesis of PRLPS, and comprehensive treatment including the surgery, radiotherapy, chemotherapy, and molecular targeted therapy were reviewed.ResultsThe pathological types of PRLPS were highly differentiated, dedifferentiated, mucoid/round cell, polymorphic, and mixed. The main molecular pathogenesis was the synergistic effect of MDM2 with related genes, abnormal expressions of c-myc gene and microRNAs, Prune-nm23-H1 mechanism, and abnormal protein products of FUS-CHOP fusion gene which regulated the growth of tumor. The treatment of PRLRS included the radical resection, extended resection, and palliative resection combined with radiotherapy, chemotherapy, and molecular targeted therapy.ConclusionsPRLPS is a rare malignant tumor with high recurrence rate, but early diagnosis and treatment are difficult. With the further study of the molecular mechanism of PRLPS, the treatment of PRLPS has been transformed into a comprehensive treatment based on surgery, adjuvant radiotherapy and chemotherapy, and molecular targeted therapy.

Application of Contrast-Enhanced Ultrasonography in Differential Diagnosis of Retroperitoneal Occupying Lesions

　Objective　To evaluate the real-time contrast-enhanced ultrasonography (CEUS) in the differential diagnosis of retroperitoneal occupying lesions. 　Methods　Thirty patients with retroperitoneal occupying lesions, including 10 benign and 20 malignant lesions, were performed with CEUS, thus describing the perfusion of contrast agent, the entering style of contrast agent and the vascular morphous. And the entering styles were divided into two patterns: peripheral type or central type while the vascular morphous were divided into 4 levels: level 0, level 1, level 2 and level 3. All of these were compared between benign and malignant lesions. Compared the results of diagnosis malignant lesions by common ultrasonography with CEUS. 　Results　1/5 case of benign substantive lesions presented as contrast agent perfusion defect, and 11/20 cases of substantive malignant lesions presented as contrast agent perfusion defect. 14/20 of malignant lesions were central type; 9/10 of benign lesions were peripheral type (P=0.005 2). In benign lesions, level 0 had 7/10， level 1 had 2/10 and level 3 had 1/10. In malignant lesions, level 0 had 1/20, level 1 had 3/20, level 2 had 8/20 and level 3 had 8/20, too (P=0.000 5). The rate of missed diagnosis was 40.00% and the accuracy was 66.67% by common ultrasonography, while the rate of missed diagnosis was 10.00% and the accuracy was 86.67% by CEUS combined with the entering style of contrast agent and the vascular morphous. 　Conclusion　The CEUS applies a new way to discriminate malignant from benign in retroperitoneal occupying lesions.

Discussion on three cases of retroperitoneal tumor involving great vessels by MDT mode under the aid of VR

ObjectiveTo explore the application value of multidisciplinary collaborative team (MDT) model in retroperitoneal tumors involving large vessels.MethodsThree cases of retroperitoneal tumors involving great vessels admitted to Xiang’an Hospital of Xiamen University in 2019 were retrospectively analyzed. With the support of 3D visual reconstruction and virtual reality (VR) technology, we performed MDT discussion and three cases received treatment of surgery, intervention, and targeted therapy.ResultsCase 1 was discussed by MDT and concluded that, based on CT examination, 3D reconstruction, and VR virtual image results, the tumor on the right side was determined to be completely resectable. The left tumor was judged to be unresectable, and the proposed treatment plan was right metastatic tumor resection + left metastatic tumor radiofrequency ablation. After surgery case 1 had been followed up for 6 months. The symptoms of diarrhea were significantly improved. CT reexamination showed that liver lesions and left retroperitoneal lesions were the same size and the condition was stable. After discussion by MDT, radiofrequency ablation around the tumor was proposed for case 2. This case was followed up for 3 months after surgery, and CT reexamination showed no new lesion in retroperitoneum. After MDT discussion, we concluded that arteriovenous fistula of case 3 had no indications for surgery, and proposed interventional combined with targeted therapy. After treatment, the tumor was found to be smaller after reexamination in 8 months than before treatment, and the efficacy was evaluated as partial remission. The follow-up was continued.ConclusionThe future development trend of retroperitoneal tumor therapy involving great vessels is to evaluate each patient’s condition under the MDT mode by using 3D visual reconstruction and VR technology, and to formulate the individualized treatment plan of operation combined with other treatments.

TREATMENT OF PANCRATIC INFECTED NECROSIS BY LUMBO-POST PERETONEAL DRAINAGE AND POSTOPERATIVE LAVAGE （REPORT OF 20 CASES）

目的 探討急性胰腺炎繼發感染的治療方法。方法 分析總結我院1998～1999年收治的20例胰腺感染患者，采用經后上腰腹膜后引流及灌洗方法治療的資料。結果 術后并發癥： 殘余膿腫2例，消化道出血1例，腸瘺4例，胰瘺6例，經治療后患者全部治愈。結論 該治療方法殘余感染及死亡率低。

兩種腹膜后腔建立方法的比較

【摘要】 目的 比較氣囊法組和直接法組建立腹膜后腔的臨床價值。 方法 對2005年5月-2008年12月32例后腹腔鏡手術建立腹膜后腔的臨床資料進行比較，統計分析兩種腹膜后腔建立方法在時間、空間大小、食指經穿刺孔能否觸及腎臟、并發癥發生率、出血量等的差別。 結果 兩種方法均成功建立腹膜后腔。氣囊法組建立腹膜后腔時間平均為（13.17±1.40） min，直接法組為（4.45±1.20） min。氣囊法組腹膜后腔空間為（396.00±13.33） mL，直接法組為（85.50±6.05） mL。氣囊法組食指經穿刺孔能觸及腎臟6例（50%），直接法組無1例（0%）。組間比較，差異有統計學意義（Plt;0.01）。兩組患者建立空間后經觀察均為少量滲血，氣囊法組發生氣囊爆裂1例。 結論 直接法組在時間上明顯優于氣囊法組，與氣囊法組比較并未增加相關并發癥，但建立的空間較小；在熟練掌握了氣囊法組后可以運用直接法組建立腹膜后腔。

Laparoscopic Surgical Treatment of Primary Retroperitoneal Tumor (Report of 12 Cases)

目的探討原發性腹膜后腫瘤行腹腔鏡手術的安全性和療效。 方法回顧性分析新疆醫科大學第二附屬醫院普外科2008年4月至2013年4月期間行腹腔鏡手術治療的12例原發性腹膜后腫瘤患者的臨床資料。 結果12例患者均行腹腔鏡手術，其中1例中轉開腹手術，其余行腹腔鏡手術成功。平均手術時間190 min，術中平均出血300 mL，術后平均8.5 d出院。術后左下肢深靜脈血栓形成1例，經保守治療好轉。圍手術期無死亡患者。術后病理類型：良性腫瘤5例，其中神經鞘瘤1例，脂肪瘤1例，腹膜后囊腫2例，畸胎瘤1例；惡性腫瘤7例，其中纖維肉瘤2例，平滑肌肉瘤1例，惡性淋巴瘤2例，脂肪肉瘤2例。良性腫瘤平均直徑8.1 cm，惡性腫瘤平均直徑5.6 cm。隨訪7例惡性腫瘤患者，平均隨訪時間13個月，無復發及轉移。 結論通過本組有限的病例資料初步得出，原發性腹膜后腫瘤的診斷主要依靠影像學檢查。對于腫瘤直徑≤10 cm的良性腫瘤或直徑≤6 cm的惡性腫瘤且未侵犯主要血管者行腹腔鏡手術治療安全、可行。

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

目的　總結1例腹膜后神經鞘瘤合并胃神經鞘瘤的臨床診療方法。 方法　2010年12月收治1例女性患者，因嘔血行CT檢查發現胃體前壁及右腎上腺區占位入院，行胃楔形切除術及右腎上腺腫瘤切除術治療。 結果　術后病理證實為腹膜后神經鞘瘤合并胃神經鞘瘤，隨訪半年無復發。 結論　腹膜后神經鞘瘤合并胃神經鞘瘤病例罕見且診斷困難，影像學檢查缺乏特異性，可依靠術后病理檢查確診；外科手術完整切除腫瘤是有效的治療方法，預后較好。