47例原发性腹膜后肿瘤的临床诊治探讨

目的 探讨原发性腹膜后肿瘤(PRT)的诊治经验.方法 回顾性分析自2005年6月至2014年6月收治的47名腹膜后肿瘤患者一般临床资料、既往史、影像学检查、手术方式、术后病理、随访记录等资料.结果 B超诊断阳性率为85.0％,CT和MRI诊断阳性率为100％.开放手术组25例,肿瘤平均直径8.06cm,人平均手术时间为154.3min,人均术中出血量790.1 mL,人均术后住院天数11.8d.腔镜组22例,肿瘤平均直径6.84cm,人均手术时间153.9min,人均术中出血量289.2mL,人均术后住院天数9.0d.两组术中出血量和术后住院天数差异有统计学意义(P＜0.05).良性肿瘤27例(57.45％),恶性肿瘤20例(42.55％).恶性PRT完整切除组的5年生存率为40.0％ (4/10),姑息切除组为0(0/8),差异有统计学意义(P＜0.05).结论 影像学检查对PRT术前诊断至关重要,腹腔镜手术在术中出血以及术后恢复方面优于开放手术,完整切除肿瘤是治疗的关键和影响预后的重要因素.

Discussion on clinical diagnosis and treatment of primary retroperitoneal tumor in 47 cases

Objectives To discuss the experience in clinical diagnosis and treatment of primary retroperitoneal tumor(PRT).Methods The clinical data of 47 patients with PRT was retrospectively analyzed including general information,previous medical history,radiological studies,operation methods,postoperative pathological and clinical follow-up data from June 2005 to June 2014.Results In radiological diagnosis,the positive rate of ultrasound,computed tomography and magnetic resonance imaging was 85.0％,100％ respectively.25 patients with PRT underwent open operation and the mean of tumor diameter,operation time,bleeding volume and postoperative hospitalization time was 8.06cm,154.3min,790.1mL and 11.8d respectively.22 patients with PRT underwent laparoscopic operation and the mean of tumor diameter,operation time,bleeding volume and postoperative hospitalization time was 6.84cm,153.9min,289.2mL and 9.0d respectively.The difference in the latter two groups(bleeding volume,postoperative hospitalization time) was significant(P ＜ 0.05).There were 27 cases of benign tumor(57.45％),20 cases of malignant tumor(42.55％).In malignant PRT,the 5-years-survival rate of complete resection group and partial resection group was 40％ (4/10) and 0(0/8) respectively.The difference between these two groups was significant (P ＜ 0.05).Conclusions Radiological studies are crucial for the diagnosis.The bleeding volume and postoperative recovery in laparoscopic surgery are superior to those in open surgery.The complete resection is the key for the treatment and prognosis of PRT.