原发性腹膜后肿瘤的诊断策略和治疗对策

Tactics in the diagnosis and strategy in the treatment of primary retroperitoneal tumor

目的 探讨原发性腹膜后肿瘤诊断程序、各项检查方法的价值以及治疗对策。方法 1985～ 2 0 0 0年经手术治疗及病理证实的原发性腹膜后肿瘤 6 3例 ,就其诊断方法、检查手段、手术方式进行分析。结果 临床表现以腹部肿物及腹部隐痛为主 ,检查手段主要为B超、CT、核磁共振 (MRI)、腹部平片、胃肠及泌尿系造影。良性肿瘤 17例 ( 2 6 7%) ,恶性肿瘤 46例 ( 73 3%)。肿瘤全切除 43例 ,其中联合脏器切除 13例。结论 原发性腹膜后肿瘤在诊断上应解决三个问题 :肿瘤定位、肿瘤定性及肿瘤与周围脏器的关系 ;诊断价值MRI >CT >B超 ;术前均应考虑联合脏器切除的可能 ,是否完整切除是治疗成败的关键 ,但腹膜后恶性淋巴瘤不应强求完全切除。

Objective To discuss the procedure of diagnosis,the value of examination methods and the treament of primary retroperitoneal tumor. Methods There were 63 cases of primary retroperitonal tumor which were proved by operation and pathology from 1985 to 2000.Mehtods of diagnosis,examination and operation of these patients were analysed.Results Pain in abdomen and abdominal mass were the most common clinical features,the main ways of examination included B-ultrasonography,CT and MRI,there were 17 cases of benign tumor(26.7%),46 cases of malignant tumor (73.3%).Totally removal of tumor was performed in 43 cases,total resection of the tumor and other implicated organs in 13 cases.Conclusion There are three issues to be resolved in the diagnosis of primary retroperitoneal tumor,which are location,nature of the tumor and relation to near organs.Value of diagnosis:MRI>CT>B-ultrasonography.We should consider the possibility of combined removal of other implicated organs before operation.Whether the tumor is removed totally is very critical in treatment.But not all retroperitoneal malignant lymphoma are required to have total resection total resection.