原发性腹膜后软组织肉瘤的诊断与治疗

目的：探讨原发性腹膜后软组织肉瘤的诊断及治疗方法。方法：回顾性分析1995年8月～2006年5月收治的12例原发性腹膜后软组织肉瘤患者的临床资料，并就其临床表现、辅助检查及手术方法进行讨论。结果：12例中，男3例，女9例，年龄27～73岁，平均55岁。体检发现者3例，有腹部或腰部疼痛症状者6例，腹部包块者2例，下肢疼痛者1例。肿瘤最大径5～21cm，平均11cm，均行手术切除。手术时间120-360min，平均210min；失血200～1500ml，平均524ml，其中输血5例，占41％，输血4001000ml，平均600ml。同时切除右肾1例，右半结肠1例，无重大手术并发症。病理检查结果为脂肪肉瘤5例，平滑肌肉瘤3例，神经纤维肉瘤2例，恶性纤维组织细胞瘤1例，横纹肌肉瘤1例。随访8例，时间3～60个月，平均28个月，2例分别于术后6、9个月复发，再次行手术切除，1例术后1．5年因肝、肺转移而死亡，2例术后3～12个月局部复发，无法手术切除，转行放、化疗。结论：原发性腹膜后软组织肉瘤术前主要靠影像学检查诊断；手术完整切除是其主要的有效治疗手段。     

应用改良下腔静脉前入路法完整切除巨大腹膜后脂肪肉瘤10例临床分析

目的 探讨改良下腔静脉前入路法在腹膜后脂肪肉瘤根治切除手术中应用的安全性和可行性。方法　回顾性分析北京大学肿瘤医院暨北京市肿瘤防治研究所软组织与腹膜后肿瘤中心2015年8月至2016年2月应用改良前入路法行肿瘤根治切除术治疗10例腹膜后巨大脂肪肉瘤病人的术中及术后资料。结果 10例病人均完整切除肿瘤。手术时间540～1000 min,术中出血800～6000 mL,联合右半肝切除2例,胰十二指肠切除术6例,右半结肠、右肾切除10例,下腔静脉切除重建5例。均达到R0切除,术后发生B级以上胰瘘1例,Clavien-DindoⅢ级以上腹腔感染2例,人工血管血栓形成1例,二次手术1例,无围手术期死亡。结论 应用改良前入路法切除右侧腹膜后巨大脂肪肉瘤安全、可行,值得开展进一步研究。     

腹膜后脂肪肉瘤的生物学特性及其诊断和治疗

目的 探讨腹膜后脂肪肉瘤生物学行为及诊断与治疗的有关问题。方法 回顾性分析1970—2005年中国医科大学附属第一医院收治的32例（共接受手术43例次）原发及复发腹膜后脂肪肉瘤病人的临床和病理资料。结果 该病主要临床表现是腹胀、腹部包块进行性增大。复发病例较原发病例生物学行为差，肿瘤侵袭力强，组织学亚型恶性程度高，手术完全切除率低。多次复发者复发间期逐渐缩短。难治性大出血是术后主要且致命的并发症。结论 腹膜后脂肪肉瘤术后易复发，很少转移，手术切除是最有效的治疗手段。完全切除者复发间期长，控制术中出血是减少术后死亡的关键。放、化疗对腹膜后脂肪肉瘤的作用有限。     

原发性腹膜后肉瘤的外科治疗68例临床报告

目的探讨原发性腹膜后肉瘤的诊断与治疗。方法对2000年1月至2010年1月经手术治疗的68例原发性腹膜后肉瘤的临床资料进行回顾性分析。结果原发性腹膜后肉瘤病理类型多样,本组68例中恶性纤维组织瘤9例,脂肪肉瘤33例,平滑肌肉瘤9例,未分化肉瘤7例,滑膜肉瘤4例,恶性外周神经鞘瘤6例。其中术后局部复发43例,5年存活率广泛切除为29%,局部切除的为43%。结论原发性腹膜后肉瘤的临床表现多为无症状性包块,组织学类型复杂,以脂肪肉瘤多见,预后与手术的彻底性和病理类型相关。     

腹膜后脂肪肉瘤29例的诊断和治疗

探讨原发性及复发性腹膜后脂肪肉瘤（PRLS）的临床病理特征、诊疗原则及预后情况。回顾性分析2015年1月—2021年12月新疆医科大学第一附属医院消化血管外科中心收治的29例腹膜后肿瘤患者的临床资料。其中,侵犯周围器官15例（51.7%）,联合器官切除16例(55.2%)。中位手术时间235 min;中位出血量300 m L。术后病理检查结果证实脂肪肉瘤诊断,术后共12例患者出现并发症：肠梗阻4例、感染性休克1例、胸腹盆腔积液6例与低钾血症1例。以上患者经积极治疗后均痊愈出院。原发性腹膜后脂肪肉瘤前期诊断困难,切除难度大、术后易复发。肿瘤切除范围、肿瘤分化程度是腹膜后脂肪肉瘤术后复发的重要影响因素。     

Primary retroperitoneal liposarcoma reoperation of 36 cases

目的 探讨原发性腹膜后脂肪肉瘤再手术的原因、处理策略及手术要点.方法 对2000年6月至2010年6月间36例腹膜后脂肪肉瘤再手术的临床资料进行回顾性分析.结果 原发性腹膜后脂肪肉瘤再手术的主要原因是手术切除不彻底和肿瘤的生物学特性.完全切除与不完全切除5年生存率分别为79.3％和34.5％.再手术后并发症以出血及肠瘘为主.结论 原发性腹膜后脂肪肉瘤再手术既有肿瘤本身原因,也与手术相关.再次手术治疗是治疗该病术后复发病例的积极手段.把握好手术时机、术中彻底切除是再手术成功的关键.     

33例复发性腹膜后肉瘤的治疗及其预后

目的探讨复发性腹膜后肉瘤的治疗方法及其预后。方法回顾性分析１９７２年～１９９６年收治的３３例复发性腹膜后肉瘤的临床资料。结果１７例（５１５％）患者在首次复发时完整切除肿瘤;２、３、１例患者分别在首次、２次和３次复发时进行联合脏器切除。共１４例患者术后接受不同剂量的放疗和化疗。对２９例患者进行６个月至１２年的随访,其中１５例（５１７％）死亡,７例生存５年以上,２例生存１０年以上。１、３、５年生存率分别为８５７％,５４９％和４２３％。结论外科手术切除肿瘤是提高复发性肉瘤生存率最重要的手段,联合脏器切除能提高肿瘤完整切除率,对多次复发的肿瘤不应放弃手术机会,放疗和化疗对复发性肉瘤可起一定的控制作用。病理类型为高分化脂肪肉瘤者,预后优于患其他类型肉瘤者     

腹膜后软组织肉瘤的放化疗进展

腹膜后软组织肉瘤约占软组织肉瘤的15％。最常见的是脂肪肉瘤，其次是平滑肌肉瘤和纤维肉瘤。无论对初次就诊还是复发的病人，主要的治疗方式是手术完整切除肿瘤，即肉眼上彻底切除肿瘤，并且尽可能达到镜下切缘阴性。手术完整切除可显著提高存活率。     

1例高分化精索脂肪肉瘤1年内3次手术治疗报告并文献复习

目的 探讨高分化精索脂肪肉瘤的临床特点及诊治方法。方法 回顾性分析1例多次复发高分化精索脂肪肉瘤患者的临床资料,结合相关文献对其临床诊治进行讨论。结果 患者初次手术行右侧精索区脂肪组织送检。术后病检提示：高分化脂肪肉瘤。随访1年内,因复发分别行双侧睾丸根治性切除术及腹膜后肿瘤切除术。结论 精索脂肪肉瘤是极为罕见的疾病,目前尚缺乏标准的治疗方案,局限性病变完整手术切除是关键,局部复发手术治疗仍是首选,无法达到R0切除,术后复发率极高,脂肪肉瘤对放疗和化疗不敏感,仍期待更确切的辅助疗法联合应用于该疾病的治疗。     

原发性腹膜后肿瘤42例的外科治疗

目的 探讨原发性腹膜后肿瘤（PRT）的诊断、治疗以及复发性腹膜后肿瘤的预防、治疗要点。方法 对1990－2000年手术且病理证实的42例原发性腹膜后肿瘤进行回顾性分析。结果 42例中良性19例，恶性23例。19例良性肿瘤完整切除15例，合并脏器切除3例，肿瘤部分切除1例，复发后再手术完整切除。23例恶性肿瘤完整切除9例，合并脏器切除11例，部分切除及探查活检3例。复发后再次及多次手术5例。全组无手术死亡。结论 影像学检查是判断手术切除范围的重要依据。施行肿瘤全切除术是治疗PRT的关键。对于复发性腹膜后肿瘤，外科手术切除仍是主要治疗手段。对多次复发的肿瘤不应放弃手术机会。     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.