29例原发性腹膜后脂肪肉瘤的诊疗分析

Diagnosis and treatment analysis of 29 cases of primary retroperitoneal liposarcoma

目的:探讨原发性腹膜后脂肪肉瘤(PRPLS)的临床特征、诊疗方法及预后情况。方法:回顾性分析我院收治的29例经病理确诊为PRPLS患者的临床资料,包括临床表现、影像学检查方法、治疗方式及预后情况。结果:PRPLS无特异性临床表现,首发症状主要为腹部包块、腰背部隐痛、腹痛及腹胀,无症状者可体检发现;术前CT检查可准确进行肿瘤定位,准确率高达96.6%;29例患者包括21例初发治疗及8例复发再治患者,于我院行手术治疗27例,仅行化疗或仅行放化疗各1例,初发治疗肿瘤完整切除率100%,复发再治肿瘤完整切除率66.7%;截至2016年7月,13例随访期间肿瘤复发,76.9%为3年内复发,复发患者均再次行手术治疗;5例随访期内死亡,其余24例均存活,其中2例行减瘤手术及1例术后复发仅行化疗的患者短期内出现复发症状,生活质量较差。结论:PRPLS早期诊断较困难,CT检查是诊断该肿瘤并行肿瘤定位的重要方法。手术切除是PRPLS的首选治疗方法,完整切除肿瘤可明显改善患者预后及生活质量。PRPLS容易复发,复发者仍然首选手术治疗。

Objective：To discuss the clinical feature,diagnosis,treatment and prognosis of primary retroperitoneal liposarcoma（PRPLS）.Method：Clinical data including clinical manifestations,imageological method,treatment and prognosis of 29 cases of PRPLS（confirmed by pathological diagnosis）treated in our hospital were analyzed retrospectively.Result：PRPLS had no specific clinical manifestations.The initial symptoms were mainly abdominal mass,lower back pain,abdominal pain and distention,and those who had no symptoms could be found through physical examination.Preoperative CT examination was an important method for this condition,for its accuracy of tumor localization diagnosis was as high as 96.6%.All patients included 21 cases of patients with incipient treatment and 8 cases of relapsed patients.Twenty-seven of them were treated surgically and the other two cases received chemotherapy or sequence radiotherapy and chemotherapy alone in our hospital.The complete tumor resection rate was 100% in initial disease while 66.7% in relapse cases.By July 2016,there were 13 cases of tumor recurrence during the follow-up period and 79.6% of them were found within 3 years.Those recurrent patients underwent surgical treatment again.In addition,5 cases died and the remaining 24 cases survived in the course of follow-up period.Moreover,2 relapsed cases that underwent incomplete surgical resection and 1 case of recurrence received chemotherapy only recurred in a short term with poor quality of life.Conclusion：Early diagnosis of PRPLS is relatively difficult.CT examination is a vital method for its diagnosis and tumor＇s localization.Surgical resection is the primary therapy for PRPLS.Complete resection can obviously improve patient＇s prognosis and quality of life.PRPLS recurs easily,and surgical treatment is still preferred for the recurrent case.