48例原发性腹膜后肿瘤的外科治疗  

Surgical Management of Primary Retroperitoneal Tumor

作　　者：王建军[1] 全志伟[1] 杨勇[1] 翁子毅[1] 陈权海[1] 杜隽铭[1] 

机构地区：[1]上海第二医科大学附属新华医院外科,上海市200092

出　　处：《中国肿瘤临床》2001年第6期422-424,共3页Chinese Journal of Clinical Oncology

摘　　要：目的：总结原发性腹膜后肿瘤的诊断和治疗经验。方法：对本院手术的48例原发性腹膜后肿瘤进行回顾性分析。生存分析采用Kaplan－Meier法，log－rank检验。结果：病理类型共13种，良性18例（37．5％），恶性30例（62．5％）。临床表现包括腹胀、腹痛、腰背酸痛、低热、消瘦、尿频尿急、月经不调和贫血。主要辅助检查为CT、B超、X线胃肠造影、泌尿系统造影和数字减影血管造影术等。18例良性肿瘤均完整切除，30例恶性肿瘤中12例（40％）实行广泛切除术，18例（60％）实行部分切除或仅作活检。实行广泛切除术者平均生存时间40±4．88个月，3年与5年生存率分别为50．0％和25．0％；而实行部分切除或仅作活检者平均生存时间20．83±2．84个月，术后3年与5年生存率则分别为16．7％和0，二者相比差异有显著意义（P＝0．002）。恶性肿瘤因复发施行多次手术7例（58．3％）。结论：原发性腹膜后肿瘤早期不易发现，应重视体格检查和影像学检查，手术是治疗本症的主要方法，良性肿瘤应完整切除，恶性肿瘤应争取作广泛切除术。本病复发率高，术后应定期随访。Objective To summarize the experience in diagnosis and treatment of primary retroperitoneal tumors PRT． Methods A total of 48 patients with PRT operated in our hospital were involved in this study for retrospective analysis． The survival rates were calculated by the Kaplan－Meier method and the differences between them were measured by log－rank test． Results There were 13 different pathological patterns． Eighteen cases were benign 37．5％ and 30 cases were malignant 62．5％． The clinical manifestations were mainly enlarging abdomen.abdomen distenson.abdominal pain.backache.low fever.weight loss.menoxenia.anemia.urgency and frequency of urination etc． The clinical accessory examinations were CT scan.ultrasonography.gastrointestinal series.barium enema.nephrography.digital subtraction angiography etc． All 18 cases of benign tumor were resected completely． Of the 30 cases of malignant tumor.12 cases 40％ received extended excisions.However.18 cases underwent partial excision or biopsy only． The mean survival time was 40±4．88 months． The 3－.5－year survival rates were 50％ and 25％ in extended resection group respectively.while those of the partial excision or biopsy group were 16．7％ and 0％ respectively .and the mean survival time of them was 20．83±2．84 months P＝0．002． Seven cases of malignant tumor were operated for several times due to local recurrence． Conclusion It is rather difficult for primary retroperitoneal tumors to be found at early stage． More attention should be paid on these suspected patients including history.physical and imaging examination． Surgical operation is the essential procedure to cure the patients． Complete excision should be done for benign tumors.but radical extended resection must be tried in malgnant ones． Regarding the high recurrence rate in malignant tumors.long term follow up is needed．

关 键 词：原发性腹膜后肿瘤 早期诊断 复发 广泛切除术 

分 类 号：R735.4[医药卫生—肿瘤] R730.56[医药卫生—临床医学]