原发性腹膜后神经源性肿瘤诊断与外科治疗  

Diagnosis and surgical therapy of primary retroperitoneal neurogenic tumors

作　　者：夏绍友[1] 李荣[1] 宋少柏[1] 梁发启[1] 

机构地区：[1]解放军总医院普通外科,北京100853

出　　处：《中华医学杂志》2009年第22期1567-1569,共3页National Medical Journal of China

摘　　要：目的探讨腹膜后神经源性肿瘤的诊断与外科治疗方法。方法回顾性分析79例腹膜后神经源性肿瘤患者的诊断、手术方式及预后。结果临床表现：29例腹痛、26例腹部包块、15例下肢疼痛麻木、9例无明显临床症状。所有患者均行B超、CT检查，均发现腹膜后占位。全部病例均行手术治疗，病理诊断良性31例，恶性48例，包括神经纤维瘤19例，神经鞘瘤8例，副神经节瘤4例，神经纤维肉瘤21例，恶性神经鞘瘤14例，恶性副神经节瘤6例，神经外胚瘤5例，神经母细胞瘤2例。原发性腹膜后神经源性肿瘤手术死亡率为1．3％。良性肿瘤3年复发率为0％，5年复发率为12．9％，再手术率为100％，5年生存率为100％，恶性肿瘤3年复发率为41．6％，再手术率为90％，5年复发率为79．1％，5年生存率为62．5％。结论B超、CT、MRI对定位诊断有决定意义，但术前定性确诊困难，手术切除是主要的治疗方法。术前需做好肠道准备并充足备血，术中注意保护受累及神经的完整性。防止肿瘤残留及处理好椎间孔部位是预防肿瘤复发的关键。Objective To explore the diagnosis and surgical therapy for retroperitoneal neurogenic tumors （PRNTs）. Methods The clinical records of 79 surgically treated patients with retroperitoneal neurogenic tumor were retrospectively analyzed. Results Twenty-nine patients presented with abdominal pain, 26 with abdominal mass, 15 with inferior extremities pain and numbness and 9 patients without clinical symptoms. Type B ultrasound （BUS） , CT scan and surgical resection were performed for all the patients. Pathological analysis identified 19 patients with neurofibroma, 8 with neurilemmoma, 4 with paraganglioma, 21 with neurofibrosareoma, 14 with malignant neurilemmoma, 6 with malignant paraganglioma, 5 with neurocetodermal tumor and 2 with neuroblastoma. The mortality rate of PRNT operation is was 1.3% , 3-year recurrence rate of benign tumor 0%, 5-year recurrence rate of benign tumor 12. 9%, reoperation rate 100% , 5-year survival rate 100%. 3 years recurrence rate of malignancy tumor 41.6% , reoperation rate 90%, 5 years recurrence rate of malignancy tumor 79.1% and 5 years survival rate is 62.5%. Conclusion BUS, CT and MRI are decisive for localization diagnosis. Surgical resection is the mainstay of therapy for this disease. Pre-operative preparation of intestinal tract and blood, maintaining the intactness of involved nerve are important for tumor resection. To prevent tumor recurrence, the key surgical techniques are to minimize tumor residues and . to handle intervertebral foramen properly.

关 键 词：腹膜后肿瘤 神经鞘瘤 诊断 

分 类 号：R734.5[医药卫生—肿瘤] R730.4[医药卫生—临床医学]