Loo R, Applebaum H, Takasugi J, Hurwitz R
Division of Pediatric Surgery, Kaiser Permanente Medical Center, Los Angeles, CA 90027.
J Pediatr Surg. 1988 Dec;23(12):1135-8. doi: 10.1016/s0022-3468(88)80329-4.
Current protocols for the treatment of neuroblastoma emphasize total or near total resection of tumor to improve survival. This is preferentially performed as a primary procedure, or is attempted at a second-look operation. Unfortunately, this tumor often grows to large size with invasion of the spinal canal, or encasement of major vascular or other retroperitoneal structures. A primary attempt at complete removal may result in difficult-to-control hemorrhage or injury to, or loss of, vital organs. A second-look procedure carries other intrinsic risks. It often must be performed during a period of chemotherapeutically induced hematologic and immunologic suppression. The presence of adhesions and dense scar tissue increases the complexity of the dissection. The Cavitron Ultrasonic Surgical Aspirator (CUSA) combines continuous fragmentation, irrigation, and aspiration in one instrument. Tissues high in water content are selectively fragmented and aspirated, while tissues high in collagen and elastin (such as blood vessels and pseudocapsular walls) are selectively spared. Five patients, two with large pelvic dumbell tumors, two with large intrathoracic tumors, and one with a seemingly unresectable large right adrenal tumor (crossing the midline with extensive aortocaval nodal involvement) had total or near-total resection accomplished using the CUSA. In these patients, initial resection of the relatively soft inner part of the tumor left a collapsed pseudocapsule, which was then removed under greatly improved exposure in a relatively small field. The constant aspiration virtually eliminated tumor spillage. Since most vessels were skeletonized without penetration, total blood loss was minimized. There were no intraoperative or postoperative complications.
目前神经母细胞瘤的治疗方案强调对肿瘤进行全切除或近全切除以提高生存率。这优先作为初次手术进行，或在二次探查手术时尝试。不幸的是，这种肿瘤常常长得很大，侵犯椎管，或包裹主要血管或其他腹膜后结构。初次试图完全切除可能导致难以控制的出血或重要器官的损伤或丧失。二次探查手术存在其他固有风险。它通常必须在化疗引起的血液学和免疫抑制期间进行。粘连和致密瘢痕组织的存在增加了解剖的复杂性。超声外科吸引器（CUSA）将连续破碎、冲洗和吸引功能整合在一台仪器中。含水量高的组织被选择性地破碎和吸出，而胶原蛋白和弹性蛋白含量高的组织（如血管和假包膜壁）则被选择性地保留。5例患者，2例患有巨大盆腔哑铃状肿瘤，2例患有巨大胸内肿瘤，1例患有看似无法切除的巨大右肾上腺肿瘤（越过中线，伴有广泛的主动脉腔静脉淋巴结受累），使用CUSA完成了全切除或近全切除。在这些患者中，最初切除肿瘤相对柔软的内部部分后留下一个塌陷的假包膜，然后在相对较小的视野中，在暴露大大改善的情况下将其切除。持续吸引几乎消除了肿瘤溢出。由于大多数血管在未穿透的情况下被骨骼化，总失血量降至最低。没有术中或术后并发症。
