女性原发性盆腔腹膜后肿瘤120例临床分析

Diagnosis and Treatment of Female Primary Pelvic Retroperitoneal Tumor:a Clinical Analysis of 120 Cases

目的探讨原发性盆腔腹膜后肿瘤(PPRT)的诊断与外科治疗,总结诊疗经验。方法收集2011-01—2018-01间郑州大学第一附属医院收治的120例女性PPRT患者的临床资料,进行回顾性分析。结果45%患者的首发症状为腹部症状,妇科检查阳性率为82.7%,MRI检查阳性率最高(93.3%)。术后病理学检查结果最常见的良恶性肿瘤分别为平滑肌瘤(21.3%)、脂肪肉瘤(26.9%)。恶性盆腔腹膜后肿瘤完全切除者3a、5a生存率为87.6%、54.3%,不完全切除者3a、5a生存率为42.1%、17.2%。对于肿瘤完全切除者,当肿瘤直径<10cm时,腹腔镜的手术时间、术中出血量、术后住院日及周围组织损伤率较开放手术组少,差异有统计学意义(t=-3.361、P=0.036,t=-3.329、P=0.002,t=-3.212、P=0.002,χ2=12.926、P=0.000)。当肿瘤直径≥10cm时,腹腔镜手术的术中出血量及术后住院时间亦少于开放手术,差异有统计学意义(t=-2.22、P=0.031,t=-5.990、P=0.000)。结论对于PPRT,妇科检查及彩超可作为常规检查项目。明确肿瘤的来源需依赖MRI、CT等影像学检查。对于直径<10cm的良性肿瘤及分化好、包膜完整、影像学检查未见明显周围组织浸润的恶性肿瘤,应首选腹腔镜手术。

Objective To discuss the diagnosis、surgical treatment of the primary pelvic retroperitoneal tumor,and summarize clinical diagnosis experience.Methods We analyse the clinical data of 120 female patients with PPRT retrospectively,who operated on in the first affiliated Hospital of Zhengzhou University from January 2011 to January 2018.Results The first symptom of female patients with PPRT was mainly abdominal symptoms(45%).The positive rate of gynecological examination was 83.9%,and the highest positive rate was MRI diagnosis (93.3%).The most common benign tumor and malignant tumor in postoperative pathology were leiomyoma (21.3%)and liposarcoma (26.9%).The 3-year and 5-year survival rates were 87.6% and 54.3% for the patients with malignant pelvic retroperitoneal tumor who did the complete tumor resection,and 42.1% and 17.2% for the patients with incomplete resection.When the tumor diameter is <10 cm ,the results were statistically significant in the operative time、intraoperative blood loss、postoperative hospital stay and peripheral tissue injury for the laparoscopic group and the open group( t =-3.361, P =0.036;t =-3.329, P =0.002;t =-3.212, P =0.002;χ 2=12.926, P =0.000).When the tumor diameter is <10 cm,the differences were statistically significant between the two group in The intraoperative blood loss and postoperative hospital stay( t =-2.22, P =0.031;t =-5.990, P =0.000).Conclusion Gynecological examination and ultrasound can be used as routine examination items,and the identification of tumor source further depends on MRI imaging and CT scans.For benign tumors with diameter <10 cm and malignant tumors with well-differentiated,intact capsule and no obvious infiltration of surrounding tissues,laparoscopy can be used as the preferred treatment.