原发性腹膜后脂肪肉瘤的诊断与治疗

Diagnosis and treatment of primary retroperitoneal liposarcoma

目的 探讨原发性腹膜后脂肪肉瘤（primary retroperitoneal liposarcoma,PRPLS）的临床病理特点、诊治及预后.方法 对华中科技大学同济医学院附属协和医院普通外科初诊的43例PRPLS患者临床病理资料进行回顾性分析.结果 43例PRPLS患者中男性32例,女性11例,年龄22~75岁,中位年龄49岁.肿瘤平均大小（17.6＆#177;10.8） cm.行CT检查38例,定性准确率为81.3%;行MRI检查8例,定性准确率为80.0%.43例患者均接受手术,其中首次手术肿瘤完整切除者40例,联合切除率为32.5%,中位随访39个月,首次手术完整切除且未复发的患者3、5年生存率分别为85.0%、80.0%,术后复发患者3、5年生存率为72.2%、61.1%.结论 PRPLS早期诊断较为困难,CT和MRI是PRPLS诊断和术后复查的重要手段.PRPLS首次手术应争取完整切除肿瘤,对大多数复发病例仍应以积极手术治疗为主,完整切除仍可获得较好的预后.

Objective To explore the clinical manifestations, diagnosis, treatment and progno- sis of primary retroperitoneal liposarcoma （PRPLS）. Methods The clinical and pathological data of 43 PRPLS patients at Wuhan Union Hospital were analyzed retrospectively. Results There were 32 males and 11 females with an age range of 22-75 years. The mean tumor size was （17. 6 ＋ 10. 8） cm and the qualitative accuracy for computed tomography （CT） and magnetic resonance imaging （MRI） examinations was 81.3% and 80. 0% respectively. Forty cases （93.0~~） underwent complete resec- tion and another 13 （32. 5%） resection along with other organs. During a mean follow-up period of 39 months, the 3- and 5-year survival rates of patients undergoing complete resection at initial operation without recurrence were 85.0% and 80. 0% versus 72. 2% and 61.1% in the postoperative recurrence group. Conclusions Early diagnosis is rather difficult for PRPLS. And CT and MRI are two impor- tant tools of diagnosis and postoperative reexamination. Complete resection at initial operation is the most effective treatment. Timely and complete resection has the rnost favorable prognosis for most re- currence cases.