继发于恶性肿瘤的腹膜后纤维化临床和影像学特征分析

The clinical findings and imaging features of retroperitoneal fibrosis secondary to malignant neoplasmas

目的探讨继发于恶性肿瘤的腹膜后纤维化(RPF)的临床和影像学特征。方法分析北京协和医院1992年7月-2010年1月住院的RPF患者共106例,以其中继发于恶性肿瘤的RPF8例为研究对象,收集患者的临床资料并进行随访,每3个月随访1次。结果 8例恶性RPF中男性5例,女性3例,平均年龄59.6岁。原发肿瘤来源:生殖系统4例,消化系统2例,血液系统及恶性神经鞘瘤各1例,其中1例同时患胃癌和膀胱癌。恶性RPF的临床症状与良性者比较并无特异,诊断主要依据影像学和病理特征。恶性RPF计算机X射线断层造影(CT)的特点:通常肿物体积更大,包绕的腹主动脉、下腔静脉可发生背离脊柱方向的移位,输尿管可能发生向外侧移位;肿物边缘多呈结节或分叶状;肿物的中心多偏向髂血管方向。CT还可评价疗效和提示预后。结论恶性RPF临床症状无特异性,但影像学表现有一定特征,有鉴别诊断意义。

Objective To analyze the clinical and imaging features of retroperitoneal fibrosis（RPF） secondary to malignant tumors.Methods We retrospectively analyzed 106 patients with retroperitoneal fibrosis from July 1992 to January 2010 in our hospital.Eight cases with malignant tumors among them were consecutively enrolled in this study.The demographic and clinical data of them were collected,and the follow-up was fulfilled every 3 months regularly.Results There were five male among the eight patients,and the mean age was 59.6 years old.The primary neoplasms were from genital system（4 cases）,digestive system（2 cases）,hematological system（1 case） and malignant neurilemmoma（1 case）.One case underwent both the stomach and bladder cancer.The clinical symptoms of malignant RPF had no typical features compared with those of the benign.However,the abdominal X-ray computed tomography（CT） exposed some important features which were special to the malignant RPF.If the RPF masses are very extensive,elevate aorta and or ureter from spine,or have a lobulated anterior margin,which clue to the malignant RPF.In the meanwhile,CT can evaluate the management effectiveness and prognosis.Definite diagnosis of the RPF mass depends on the pathology findings.Conclusions Familiarity with the imaging manifestations of retroperitoneal fibrosis is vital to the differential diagnosis.