84例腹膜后神经鞘瘤的临床分析  

Clinical analysis of 84 cases with retroperitoneal schwannomas

作　　者：常骁[1] 沈诞[2] 年新文[1] 任善成[1] 张振声[1] 侯建国[1] 孙颖浩[1] CHANG Xiao SHEN Dan NIAN Xinwen REN Shancheng ZHANG Zhensheng HOU Jianguo SUN Yinghao(Department of Urology, Changhai Hospital, Shanghai 200433, China Department of Urology, Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]第二军医大学附属长海医院泌尿外科,上海200433 [2]解放军总医院泌尿外科,北京100853

出　　处：《解放军医学院学报》2016年第9期952-955,共4页Academic Journal of Chinese PLA Medical School

摘　　要：目的探讨神经鞘瘤的诊断和治疗要点,帮助临床医生更好地处理罕见部位的神经鞘瘤。方法回顾性分析1997年1月3日-2015年11月20日第二军医大学附属长海医院收治的84例原发性腹膜后神经鞘瘤病例(其中3例恶性),并对复发、5年生存率等预后指标进行随访。结果 84例中,男性40例,女性44例,中位年龄45岁。43例(51.2%)无特殊主诉,于体检时发现;41例有不同程度的腹部症状。CT常显示为腹膜后质地不均匀肿块,MRI检查中发现特殊"靶征"可帮助诊断,确诊主要依靠术后病理及免疫组化S100结果。本组83例行手术治疗,其中73例为开放式(88.0%),10例(12.0%)为腹腔镜辅助(1例为达芬奇机器人辅助);另有3例恶性行化疗。良性病例根治性切除后5年特异性生存率为100%;3例恶性者预后较差,且对化疗不敏感。结论腹膜后神经鞘瘤是一种少见的良性肿瘤,术前诊断困难,手术完整切除是主要的治疗手段,预后较好,确诊主要依靠病理和免疫组化;极少数恶性者预后差。Objective To investigate the diagnosis and treatment of retroperitoneal schwannomas, in order to help clinicians manage this kind of tumor in some unusual locations. Methods From January 3, 1997 to November 20, 2015, clinical data about 84 patients with pathologically proven retroperitoneal schwannomas who were treated in our center were retrospectively analyzed, and the reccurrence, 5-year survival rate and related indexes of these patients were followed up. Results There were 44 females and 40 males with a median age of 45 years（ranging from 23 to 58 years）. Forty-three（51.2%） patients with occult onset were diagnosed through health examination, and 41 cases were presented with abdominal discomfort. Computed tomography scanning showed a heterogenous retroperitoneal mass, and a specific ＇target sign＇ was shown in MRI, which might be helpful to diagnosis. Immunohistochemical staining showed positive for S-100, which was a significant criterion for pathological diagnosis. Of the 83 patients undergoing surgery, 73（88.0%） patients received surgical resections by laparotomic approach, 10（12.0%） patients by laparoscopic approach（one case was assisted by Da Vinci surgical system）. All of the patients with benign tumor had good prognosis with 5-year survival of 100%, while 3 cases with malignancy were not sensitive to chemotherapy with poor prognosis. Conclusion Retroperitoneal schwannoma is a rare tumor with good long-term prognosis. Most of them are quite difficult to diagnose preoperatively, and the main treatment of retroperitoneal schwannoma is surgical excision.

关 键 词：腹膜后肿瘤 神经鞘瘤 诊断 治疗 

分 类 号：R735.4[医药卫生—肿瘤]