原发性腹膜后肿瘤51例诊治分析.docVIP

原发性腹膜后肿瘤51例诊治分析 作者：王术明，宋军，李文美，李向农 【摘要】 目的 总结 原发性腹膜后肿瘤(PRT)诊断和 治疗 经验。方法 对我院2003年1月—2009年3月经手术治疗的51例原发性腹膜后肿瘤的临床资料、随访结果进行回顾性分析。结果 PRT临床表现多为腹部包块、腹痛、消化道症状；B超、CT及MRI诊断率较高；病理检查示良性25例，恶性26例；手术完整切除32例，联合脏器切除15例，姑息切除3例，不能切除1例；随访39例，复发11例。结论 B超、CT及MRI是早期诊断原发性腹膜后肿瘤的影像学检查手段；肿瘤完整切除，必要时行联合脏器切除是主要的治疗方法，对复发性的腹膜后肿瘤仍应争取手术切除。 【关键词】 原发性腹膜后肿瘤；诊断；治疗 　　Abstract： Objective To summarize the clinical experience of diagnosis and the management of primary retroperitoneal tumor (PRT). Methods A retrospective analysis was conducted on the clinical data and follow-ups of 51 patients with primary retroperitoneal tumor between 2003 and 2009 in the affiliated hospital of Xuzhou medical college. Results The usual clinical presentations were abdominal mass, pain and symptoms of digestive tract. Type-B ultrasonography, CT scan and MRI had higher diagnostic rate. There were 25 cases of benign tumor and 26 cases of malignant tumor, of which 32 cases recEived complete resection, 15 cases recEIved combined resection, 3 cases received palliative resection and 1 case was unresectable. Follow-up of 39 patients for 3 months to 5 years revealed that 11 cases had recurrence. Conclusion Type-B ultrasonography, CT scan and MRI are the most effective diagnostic methods for PRT. The radical or combined resection is the critical therapy. It is necessary to have surgical resection for recurrent PRT. 　　Key words: primary retroperitoneal tumor; diagnosis; therapy 原发性腹膜后肿瘤（primary retroperitoneal tumor，PRT）是指起源于膈平面至骨盆入口腹膜后间隙的间皮组织（如脂肪、结缔组织、筋膜、肌组织和淋巴结等）、神经组织及胚胎残留组织的肿瘤，不包括腹膜后器官肿瘤及转移性肿瘤。该病发病率低，诊断率低，与腹膜后重要器官和血管联系密切，完整切除困难，且术后易复发。2003年1月—2009年3月，我院经手术证实腹膜后肿瘤共51例，现将诊治情况分析如下。 　 　1 资料和方法 　　1.1 临床资料 　　本组51例患者中，男28例，女23例；年龄4个月～85岁，平均42.8岁；病程2天～1年，平均2.6个月。首发症状：腹部包块20例，腹部疼痛19例，消化道症状5例，体检发现5例，进行性消瘦、乏力2例。 　　1.2 辅助检查 　　术前行B超检查51例，有阳性发现者45例。术前行CT检查40例，MRI检查11例，穿刺细胞学检查4例，均有阳性发现。行消化道造影5例，阳性发现4例。行静脉肾盂造影6例，阳性发现3例。 　　1.3 病理类型 　　术后病理检查证实恶性26例（50.98%）；其中，恶性畸胎瘤5例，平滑肌肉瘤2例，恶性间质瘤2例，副神经节瘤1例，脂肪肉瘤6例，软组织肉瘤2例，透明细胞癌1例，神经外胚层肿瘤1例，恶性神经鞘瘤1例，横纹肌