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地坛医院为HIV感染者实施腹膜后巨大肿瘤手术
来源：搜狐健康 作者：陈明莲 张正尤 2011年01月04日14:04
2011年元旦的钟声刚刚响起，术后第八天的小伙子大踏步来到北京地坛医院护士站，他要把这新年的第一句祝福送给赋予他第二次生命的医护人员！他最想告诉所有人的是"珍惜生命，爱家人，爱生活！让生命更有意义！"
接受手术的这个小伙子来自广西，今年29岁，半年前他就感到自己的腹部有个硬块，而且随着心脏的波动而上下跳动。可是一向认为自己身体好、爱运动的他没把这包块儿放在心上，直到上个月的一天他才把自己的肚子的变化告诉妻子。在医院工作的妻子一摸丈夫的肚子，马上觉得事情不妙。果然，当地医院结果提示小陈肚子里的硬块是极为少见的腹膜后肿瘤，诊"腹膜后巨大肿瘤"，但是专家也明确表示，因为肿瘤位置特殊，肿瘤被大的动脉、静脉血管包裹，无法手术。两口子又到广西、广东两家顶尖级医院就医咨询，得到的答案都是无法治疗。当时他们还没有敢暴露患者合并HIV（艾滋病病毒）感染的特殊病史。经过网络查询，比较了上海、北京多家医院，然后他们选择了北京地坛医院。
2010年12月24日，手术开始了，正如术前各地专家预料到的一致肿瘤跨骑在腹主动脉之上，下腔静脉受肿瘤压迫管腔狭窄，腹主动脉发出的腹腔动脉干和肠系膜上动脉分别横亘在肿瘤背侧上下缘。肿瘤的下极紧贴双侧肾脏动静脉起始部，肿瘤腹侧上极附着有脾静脉和门静脉主干，肿瘤腹侧右缘附着有肠系膜上静脉。主刀医生穆毅形象地形容为"用腹腔内的大血管为肿瘤编织了一个网套"。分离覆盖在肿瘤表面的织组和器官后，肿瘤终于显露出其真实面目。肿瘤真实情况比术前预想的更为复杂，其除紧紧被腹腔内各主要血管包绕外，更为严重的是由这些主要血管发出密密麻麻的血管支互相交织成网包绕着肿瘤，轻轻触动肿瘤就可能造成血管破裂出血，而且门静脉、肠系膜上静脉和脾静脉已受肿瘤压迫管腔塌陷，血流变得极为缓慢。
手术进行的十分艰难，满布于肿瘤表面的细小血管被一一仔细分离、切断、结扎，随之脾静脉与肿瘤分离，继之肠系膜上静脉、门静脉、腹腔动脉干和双肾动静脉、下腔静脉分别与肿瘤分离......。肿瘤背侧的腹主动脉也通过动脉鞘内分离，逐渐离开肿瘤。渐渐肿瘤被分离了出来，而此时最为严峻的挑战出现了。由于肠系膜上动脉起始部被肿瘤完全包绕，穿过肿瘤实质，不能与肿瘤实质分离。仅切除已游离的大部分肿瘤，保留包绕肠系膜上动脉的肿瘤组织，虽然不伤及肠系膜上动脉，但术后肿瘤会很快复发转移。要完整切除肿瘤，必须一同切除部分肠系膜上动脉，这将造成小肠和大部分结肠的坏死。面对进退维谷的困境，穆毅再次探查肿瘤与肠系膜上动脉间关系后，决定通过切除部分肠系膜上动脉并重建肠系膜上动脉而完整切除肿瘤。当一个个血管剥离、切割、再结扎。术者的护目镜（为艾滋病感染者进行手术时的必要保护）一次次被汗水模糊、又护士擦亮。艺高人胆大，细细剥离、快速结扎，穆毅全身心地投入手术之中，但他并没有忘记接受手术的患者还是个艾滋病感染者，稍微的闪失划破手套，那么这种大量的带有艾滋病病毒的血液接触术者，感染艾滋几乎很难幸免。助手担心、家属揪心。经过5个小时的拼搏，一个直径15厘米比一个成年人的拳头还要大的肿瘤被拿下。
"这个手术的难度，比肝移植要大。也是我经历过的风险最高的手术。"完成腹膜后巨大肿瘤合并HIV感染的术者主任医师穆毅这样评价这台极为特殊的手术。这位在肝胆外科职业20多年的北京地坛医院外科主任，参与完成北京首例HIV肝移植手术的术者，历经肝移植手术不下50台，主刀肝胆手术2000多台，却着实为此前这个令人棘手的腹膜后巨大肿瘤合并艾滋病感染手术的难度、风险度打了最高分。
"如果任其发展，半年后肿瘤就会压迫血管，患者生命也就此完结。其实，术前我也知道这个手术的风险高、难度大，可病人、家属的信任，让我信心满满。"穆毅说，"小伙子还很年轻，现在艾滋病有了很好的控制方法，拿掉肿瘤，他的生活质量应该不成问题。"
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| 图示∶2010年12月即将出版的《中国特色医疗金鉴》登载的刘君主任及其机构 |
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AIDS prevention and control of the situation is still not optimistic
Ditan Hospital for the implementation of HIV infection huge retroperitoneal tumor surgery
Source: Sohu health of: Chenming Lian Zhang Zheng, especially at 14:04 on January 4, 2011
New Year's Day 2011, the bell had just sounded, the eighth day after the young man strides to the altar to Beijing hospital nurse stations, he wanted the first sentence of this New Year to give his blessing to a second staff of life! He most wanted to tell everyone that "respect for life, love of family, love life! Make life more meaningful!"
This young man underwent surgery from Guangxi, 29 years old, six months ago he felt a lump on his stomach, and with the heart jumping up and down fluctuations. But always think that their good health, love sports, he did not mind this bag pieces, until one day last month, he only changes his stomach to his wife. Touched his wife in the hospital her husband in the stomach and immediately felt something was wrong. Sure enough, the local hospital results suggest that the lump Chen stomach is extremely rare retroperitoneal tumor, patient, "a huge retroperitoneal tumor," but experts also clear that because of the special location of the tumor, the tumor was large artery, vein wrapping, can not surgery. The couple went to Guangxi, Guangdong and the two top-level hospital consultation, the answer is no cure. At that time they have not dared to expose patients with HIV (AIDS virus) infection in a special history. Query through the network, compared to Shanghai, Beijing, many hospitals, and they chose the Beijing Ditan Hospital.
December 24, 2010, surgery began, as expected before surgery to the same experts around the tumor in the abdominal aorta cross riding on top of the inferior vena cava compression by the tumor stenosis, issued by the abdominal aorta and mesenteric celiac arterial trunk artery, respectively, up and down the pathway of the dorsal margin of the tumor. Bilateral tumors of the lower pole renal artery and vein close to the beginning part of the tumor attached to the upper pole of the ventral splenic vein and portal vein, the right ventral margin of the tumor attached to a superior mesenteric vein. Surgeon Mu Yi, vividly described as "the great vessels with intra-abdominal tumor woven a network sets." Cover the surface of separation of organized groups in the tumor and organs, the tumor was finally revealing his true face. Preoperative tumor than expected, the real situation is more complex, its addition to the abdominal cavity is tightly wrapping the major blood vessels, the more serious issue by the major blood vessels densely intertwined arteries around the tumor into a network packet, light light touch may cause the tumor to rupture of blood vessels, and portal vein, superior mesenteric vein and splenic vein has collapsed lumen by tumor compression, blood flow becomes extremely slow.
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