腹膜后副神经节瘤39例临床分析

Clinical analysis of 39 cases of retroperitoneal paraganglioma

目的总结腹膜后副神经节瘤患者的临床病理特点及诊治经验。方法回顾性分析自2012年10月1日至2022年10月1日西安交通大学第一附属医院收治的39例经术后病理诊断证实为腹膜后副神经节瘤患者的临床病理及随访等资料。结果39例腹膜后副神经节瘤患者中男19例,女20例,功能型11例(28%),无功能型28例(72%)。19例行CT血管造影提示肿瘤多分布于腹主动脉与下腔静脉周围。39例患者均接受手术治疗,腹腔镜组在手术时间、术后住院时间上优于开放组,差异具有统计学意义[(135±66)min比(194±67)min,t=-2.529,P=0.016;(6.6±2.2)d比(9.6±4.8)d,t=-2.096,P=0.043]。两组术中出血量差异无统计学意义[(152±151)ml比(361±608)ml,t=-1.169,P=0.250]。腹腔镜组术后未出现并发症,开放组术后1例发生肺部感染,1例发生肠梗阻。36例获有效随访,失访3例,随访时间为2~115个月,腹腔镜组1例患者术后1年因肿瘤原位复发合并肝脏转移而死亡,开放组1例术后2年肿瘤原位复发,经二次手术康复出院,1例术后2年肿瘤原位复发侵犯大血管而死亡。结论完整的手术切除是腹膜后副神经节瘤治愈的希望,充分的围手术期处理是手术成功的关键。腹腔镜手术在缩短手术时间和术后恢复方面优于开放手术。

Objective To summarize the clinicopathologic features and clinical diagnosis and treatment experience of retroperitoneal paraganglioma.Methods This study retrospectively analyzed the clinical,pathological and follow-up data of 39 patients admitted to the First Affiliated Hospital of Xi'an Jiaotong University from 1 Oct 2012 to 1 Oct 2022 for retroperitoneal paragangliomas undergoing resection.Results There were 19 males and 20 females with tumor being functional in 11 cases(28%)and non-functional in 28 cases(72%).CT angiography showed that the tumors were distributed around the abdominal aorta and inferior vena cava in most cases.All 39 patients underwent tumor rescetion.Patients in laparoscopic group had shorter operation time and postoperative hospital saty compared with open sugery[(135±66)min vs.(194±67)min,t=-2.529,P=0.016;(6.6±2.2)d vs.(9.6±4.8)d,t=-2.096,P=0.043],while there was no statistically significant difference between the two groups in terms of intraoperative blood loss[(152±151)ml vs.(361±608)ml,t=-1.169,P=0.250].There were no major postoperative complications in the laparoscopic group,and pulmonary infection in 1 case and intestinal obstruction in 1 case in the open group.Thrity-six cases were followed up,ranging from 2 to 115 months,1 patient in the laparoscopic group died 1 year after surgery due to recurrence and metastasis.In the open group,1 case recurred 2 years later and was discharged after the second operation,and 1 case died of recurrence 2 years after surgery.Conclusions Surgery is indicated for retroperitoneal paraganglioma.Adequate perioperative management is the key to the success of the operation.Laparoscopic surgery is superior to open surgery in terms of operation time and postoperative recovery.