原发性腹膜后脂肪肉瘤复发和预后的影响因素  

Analysis of recurrent and prognosis factors of primary retroperitoneal liposarcoma

作　　者：张大岭 丁亚飞[1] 张心全 邹沪煌 王涛[1] 王军[1] 姚文诚[1] 贾占奎[1] 党晓卫[2] 杨锦建[1] Zhang Daling;Ding Yafei;Zhang Xinquan;Zou Huhuang;Wang Tao;Wang Jun;Yao Wencheng;Jia Zhankui;Dang Xiaowei;Yang Jinjian(Department of Urology,The First Affiliated Hospital Zhengzhou University,Zhengzhou 450052,China;Department of Hepatobiliary and Pancreatic Surgery,The First Affiliated Hospital Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院泌尿外科,450052 [2]郑州大学第一附属医院肝胆胰外科,450052

出　　处：《中华泌尿外科杂志》2021年第2期137-143,共7页Chinese Journal of Urology

摘　　要：目的探讨原发性腹膜后脂肪肉瘤复发和预后的影响因素。方法回顾性分析2011年6月至2020年1月郑州大学第一附属医院接受手术治疗的89例原发性腹膜后脂肪肉瘤患者的临床资料,男42例,女47例。中位年龄53(26~78)岁。我院首次手术治疗65例,外院术后复发再次手术治疗24例。初诊临床表现:体检发现腹膜后肿物41例,腹胀12例,腹痛10例,发热11例,恶心、呕吐、纳差8例,尿频、排尿困难6例,双下肢水肿1例。术前CT检查示肿瘤主体位于腹膜后肾区58例,位于腹膜后间隙、盆腔腹膜外间隙31例;肿瘤单发55例,多发34例。肿瘤长径中位值20(3~52)cm。首诊65例中通过术前影像学检查考虑为原发性腹膜后脂肪肉瘤47例(72.3%)。89例手术中,腔镜手术78例,其中腹腔镜手术21例,后腹腔镜手术38例,达芬奇机器人辅助腹腔镜手术19例;开放手术11例。87例行根治性切除术,2例行姑息性切除术;42例术中行邻近脏器切除术。对患者复发及生存情况进行随访。结果本组89例手术均顺利完成。术中出血量中位值200(10~2000)ml。病理类型为高分化型23例,去分化型40例,黏液样/圆形细胞型20例,多形性型5例,混合型1例。组织学分级低级别42例,高级别47例。术后中位随访时间28(3~108)个月。患者5年无复发生存率、无病生存率和总生存率分别为16.7%、16.1%和52.6%。57例局部复发,1例肺转移,1例肝转移,中位无病生存时间24个月;42例死亡,中位生存时间64个月。单因素分析结果显示,术中出血量(P<0.01)、肿瘤是否多发(P<0.01)、病理类型(P<0.01)、组织学分级(P<0.01)是影响无病生存时间的相关因素;术中出血量(P<0.01)、肿瘤是否多发(P<0.05)、病理类型(P<0.05)、是否复发(P<0.01)是影响总生存时间的相关因素。性别、年龄、肿瘤大小、肿瘤部位、是否初次手术、是否根治性切除、是否联合邻近脏器切除对患者的预后生存无影响(P>0.05)。CObjective To investigate the factors related to recurrence and prognosis of retroperitoneal liposarcoma.Method The clinical data of patients with primary retroperitoneal liposarcoma who underwent surgical treatment in the First Affiliated Hospital of Zhengzhou University from June 2011 to January 2020 were analyzed retrospectively.There were 42 males and 47 females and patients’median age was 53(26-78).Sixty-five cases were treated by operation in our hospital,and 24 cases were primarily treated by the operation in another hospital.The clinical manifestations of the initial diagnosis included retroperitoneal mass in 41 cases,abdominal distension in 12 cases,abdominal pain in 10 cases,fever in 11 cases,nausea,vomiting and poor appetite in 8 cases,frequent urination and dysuria in 6 cases,and bilateral lower limb edema in 1 case.Preoperative CT imaging showed that the tumor body was located in the retroperitoneal kidney area in 58 cases,while in the retroperitoneal space or the pelvic extraperitoneal space in 31 cases.There were 55 single cases and 34 multiple cases.The median tumor length was 20(3-52)cm.Among the primarily treated 65 patients,47(72.3%)were considered as primary retroperitoneal liposarcoma by preoperative imaging examination.Among the 89 patients treated by surgery,78 underwent endoscopic surgery,among which 21 underwent laparoscopic surgery,38 cases of retroperitoneal laparoscopic surgery,19 cases of Da Vinci robot-assisted laparoscopic surgery.Open operation was performed in 11 cases.There were 87 patients undergoing radical resection and 2 patients undergoing palliative resection.Forty-two patients underwent intraoperative combined resection of the adjacent organs.The recurrence and survival status of patients were followed up.Results All the 89 patients underwent the operation successfully,with the median operative blood loss of 200(10-2000)ml.There were 23 cases being diagnosed of well differentiated liposarcoma,40 cases of dedifferentiated,20 cases of myxoid/round,5 cases of myxoid liposarc

关 键 词：腹膜后 脂肪肉瘤 复发 预后 

分 类 号：R735.4[医药卫生—肿瘤]