成人原发性腹膜后肿瘤的诊断与治疗

Diagnosis and treatment of adult primary retroperitoneal tumor.

目的探讨成人原发性腹膜后肿瘤的早期诊断及治疗。方法１９５５～１９９７年经手术和活检证实的成人原发性腹膜后肿瘤１３４例，就其年龄、病情、临床表现及辅助检查的特点进行比较。结果首发症状及体征多数为腹痛及腹块，腹块并有压痛者多为恶性，＜２０岁及＞６０岁发病者恶性多见。平均病程２０４个月，＜１年者多为恶性。肿瘤大小与良恶性无关，术前确诊率为４１８％，Ｂ超及ＣＴ的诊断率分别为４８５％、７０２％。本组良性肿瘤切除率９３２％，恶性肿瘤４２２％，术后复发１４例，６例再次行根治术。结论Ｂ超及ＣＴ是本病诊断的重要手段，术前Ｂ超引导针吸细胞学检查可提高确诊率。治疗以完整手术切除为主，对侵犯脏器者采用累及脏器一并切除，术后复发者可再次手术。

Objective To explore the early diagnosis and treatment of the adult primary retroperitoneal tumor.Methods 134 cases of primary retroperitoneal tumor which proved by operation and biopsy from 1955 to 1977 were studied.Results Abdominal pain is the main symptom,abdominal mass is the main sign when the patient came to see the doctor.Most tumor with both abdominal mass and tenderness are malignant.Malignant tumor are often found in patients<20 years old and >60 years old.Average time from onset of the disease to operation is 20 4 months,if it is shorter than 1 year,the tumor might be considered as malignant.We also find that there is no relationship between tumor size and differential level,41 8% of the patient got correct diagnosis before operation,while the diagnosis is mainly depended on B-ultrasonography and CT scann.Removal rate of benign tumor was 93 2%.While malignant tumor was 42 2% in our group.Conclusion B-ultrasnography and CT scan are main means to diagnose the primary retroperitoneal tumor.Cytologic study through needle puncture under B ultrasonography can promote the confirmed diagnosis rate.Totally removal of tumor part and total resection of other implicated organs is the best way of treatment.Patients with recurrent can be treated with reoperation.