原发性腹膜后肿瘤的诊断和治疗(附244例临床资料分析)

Diagnosis and Treatment of 244 Cases of Primary Retroperitoneal Tumor(with Analysis of 244 Cases)

目的 探讨不同病理类型的原发性腹膜后肿瘤 (PRPT)的最佳诊断和治疗手段。方法 对经病理学证实的 2 4 4例PRPT的临床表现、病理类型、影像学检查和治疗进行回顾性分析总结。结果 ①PRPT中的主要症状为腹部包块 ( 61.3 % )和腹痛 ( 2 5.8% ) ;无症状早期病例 2 1例 ( 8.6% ) ;②恶性腹膜后肿瘤以平滑肌肉瘤、脂肪肉瘤和纤维肉瘤最多见 ,良性中以畸胎瘤最多见 ;③影像学检查腹部平片阳性发现率仅为 2 8.2 % ,消化道钡餐或钡剂灌肠检出率 68.7% ,B超检出率为 86.9% ,CT检查阳性发现率为 92 .1% ;④良性肿瘤手术完全切除率为 91.5% ,恶性肿瘤为 51.2 % ,无症状的恶性PRPT为 85.7% .结论 PRPT早期诊断困难 ,B超和CT是诊断PRPT的最好方法 ,手术切除是治疗PRPT的主要手段 ,对复发性PRPT应积极创造条件 。

Objective To explore the diagnosis and treatment of the primary retroperitoneal tumor(PRPT).Method 244 cases of primary retroperitoneal tumor,which proved by operation and biopsy from January 1970 to April 1998 were studied.Result 21 cases without symptoms were diagnosised accidently in our group,about 8.6%.Abdominal pain was the main symptom (61.3%)and abdominal mass was the main sign (25.8%).Histopathology revealed that the most common malignant retroperitoneal tumors were leiomyosarcoma,liposarcoma and fibroscomain in descending order of frequency,the most common benign retroperitoneal tumor was teratoma.The diagnosis was mainly depended on B ultrasonography and CT scan.The whole resection rate of benign was 91.5% and 51.2% of malignant,whereas 85.7% of those malignant patients in early stage who had no symptoms in our group.47 cases had resection again for the local recurrence,11 of 37 recurrent malignant cases had the whole resection.Conclusion B ultrasonography and CT scan are main means to diagnosis the primary retroperitoneal tumor,whole resection is the best way of treatment.Patients with recurrent disease should be treated with reoperation as possible.