原发性腹膜后肿瘤30例报告

目的　探讨原发性腹膜后肿瘤的诊断及手术要点。方法　对1988～1998年手术治疗的原发性腹膜后肿瘤30例进行分析。结果　恶性肿瘤28例,良性肿瘤2例。无手术死亡,因并发症死亡1例。结论　B超是最基本的诊断方法,CT有助于对肿瘤与邻近脏器关系的判断,DSA对肿瘤血供的显示有助于术中控制出血。施行肿瘤全切除术是治疗腹膜后肿瘤的关键,肿瘤包膜应尽可能切除,术前对联合脏器切除应有充分的准备。     

原发性腹膜后肿瘤诊断与治疗

原发性腹膜后肿瘤诊断与治疗董春生天津市天津医院（天津３００２１１）原发性腹膜后肿瘤临床上比较少见，我院自１９７３年４月到１９９３年４月，２０年间共收治原发性腹膜后肿瘤６８例，均经手术及病理证实。本文就其诊断与治疗进行分析与探讨。１临床资料１．１一般资...     

原发性腹膜后肿瘤14例的诊断和治疗

回顾性分析14例腹膜后肿瘤患者的临床资料。14例中完整切除8例，包膜内切除1例，部分切除4例，仅取活检1例。本组无手术死亡。笔者的体会是：腹膜后肿瘤早期诊断困难，切除困难．复发率高，预后差。提示提高早期诊治水平是改善腹膜后肿瘤预后的关键。     

原发性腹膜后肿瘤26例临床分析

目的　提高腹膜后肿瘤的手术切除率和患者的生存率。方法　回顾分析 1987～ 1999年原发性腹膜后肿瘤 2 6例 ,其中良性 9例 ,恶性 17例 ,全组切除 19例 ,姑息性切除 3例 ,探查活检 3例 ,手术死亡 1例。结果　随诊 2 4例 ,良性肿瘤 8例存活 ,恶性肿瘤完全切除组的 1、3、5年生存率分别为 80 .7%、5 9.5 %、31.6 % ,姑息切除和探查活检者预后均差。结论　提高切除率是改善预后的关键 ,尽可能完整、整块切除肿瘤及其受累器官和组织 ,将降低复发率 ,提高生存率。强调积极处理复发肿瘤。     

Retroperitoneal schwannoma

BACKGROUND: Retroperitoneal schwannomas are rare, benign tumors. The aim of this study is to present our surgical experience with 7 such tumors. METHODS: Between 1989 and 2004, 7 patients with pathologically proven retroperitoneal schwannomas were reviewed retrospectively. RESULTS: There were 6 male patients and 1 female patient, with a mean age of 43 years (range, 23 to 58 years). Two patients were symptomatic and presented with abdominal discomfort, and none of the patients suffered from von Recklinghausen's disease. All the patients underwent computed tomography scanning, which showed a heterogenous retroperitoneal mass, 4 of which were thought to arise from the adrenals. In 2 patients, calcification was seen in the tumors. All 7 of the patients had a preoperative diagnosis of a retroperitoneal tumor including 3 patients who were thought to have adrenal neoplasms (1 patient had a diagnosis of an adrenal neoplasm excluded on magnetic resonance imaging). Laparotomy and complete excision of tumors were performed in all the patients, and there was no morbidity or mortality. The schwannomas had a mean maximum diameter of 7.3 cm (range, 4 to 14 cm), and they were all benign. At a mean follow-up of 17 months (range, 3 to 48 months) postresection, all the patients remained free from recurrence. CONCLUSION: Retroperitoneal schwannomas are rare tumors that are difficult to diagnose preoperatively. Radiologic findings are usually nondiagnostic. The treatment of choice is complete surgical excision.     

原发性腹膜后肿瘤的诊断与治疗

目的：总结原发性腹膜后肿瘤（PRT）的诊断方法和手术经验。方法：回顾性分析2007年5月至2009年4月38例经手术治疗的PRT患者,总结分析其影像学特点、病理学类型、手术治疗及随访结果。结果：良性肿瘤11例,恶性肿瘤27例,均经病理证实为PRT。肿瘤完整切除36例,姑息性切除1例,细针穿刺活检1例;合并脏器切除及血管切除重建11例;复发9例,复发后完整切除8例,姑息性切除1例。随访时间为20～43个月,11例良性肿瘤患者的1、3年生存率分别为100%和90.9%。24例恶性肿瘤患者的1、3年生存率分别为66.7%和33.3%。结论：影像学检查对PRT术前诊断和手术方式的选择具有指导意义,完整切除肿瘤,必要时合并脏器切除及血管切除重建时治疗本病的最有效的方法。     

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目的 提高对原发性盆腔腹膜后肿瘤（PPRT）的诊治水平。方法 回顾性分析1980年1月至2000年6月收治的PPRT35例。结果 PPRT的临床表现呈多样性、无特异症状，主要以直肠和膀胱受压症状为主，由CT、B超、MRI检查首先发现病变者85.7%(30/35)，肛诊阳性者54.3%(19/35)。手术的特点是合并脏器切除者多（40.4%)，副损伤多（17.0%)，术中发生大出血者多（19.1%)。结论 手术切除是PPRT的主要治疗方法，大出血是术中最危险的并发症，肛诊和B超、CT、MRI是发现病变的主要方法和定位手段。早期发现，详细的术前检查和准备对防止并发症十分重要。     

腹膜后纤维化16例诊治体会

为了提高对腹膜后纤维化的认识和诊治效果，总结１９７９年１１月～１９９５年６月收治腹膜后纤维化患者１６例，男７例，女９例。年龄２４～７０岁，平均４４岁。原发性者１１例，继发于恶性肿瘤者５例。手术治疗１１例，术后加用激素治疗，原发性者预后良好，继发于恶性者死亡４例。对本病的诊断和治疗进行了讨论。     

Tumor-Forming Idiopathic Retroperitoneal Fibrosis: Report of a Case

Idiopathic retroperitoneal fibrosis (IRF) is characterized by the progressive proliferation of connective tissue, but it rarely results in the formation of a mass. Herein, we report a rare case of tumor-forming IRF. A 76-year-old woman was referred to our hospital after a tumor in the right retroperitoneum was found by ultrasonography and computed tomography. Magnetic resonance imaging showed a 5 × 8 × 5-cm irregularly shaped tumor, lying adjacent to the right kidney, with a high-intensity T1-weighted image and a high-intensity T2-weighted image. Hormonal levels were within normal limits. Surgery was performed because of the possibility of an adrenal cancer. The tumor was firm, measured 7 × 8 × 4cm, and weighed 115g. The pathological diagnosis was retroperitoneal fibrosis. It is very difficult to distinguish tumor-forming IRF from malignancy. Several examinations, including needle aspiration cytology and biopsy, are necessary for the diagnosis and treatment of this disease.     

后腹腔镜肾上腺切除术（附193例报告）

目的总结后腹腔镜肾上腺切除术的手术治疗经验。方法本组193例术前均经超声、CT或CT动脉造影（CTA）等证实为肾上腺占位性病变。男70例，女123例，年龄12-74岁。右侧77例，左侧106例，双侧10例。193例患者均接受后腹腔镜肾上腺切除术。结果4例因出血中转丌放手术，其余均在腹腔镜下完成手术。平均手术时间（92±12）min，出血量（56±10）ml，术后住院天数（7．3±0．8）d。肿瘤最大径0．5～7．5cm，平均3．25cm。术后无并发症发生。随访1～24个月，2例死于肿瘤恶化。结论后腹腔镜肾上腺切除术对最大径〈8cm的肾上腺肿瘤安全、有效，创伤小、出血少、术后恢复快。     

单孔腹腔镜在腹膜后手术中的初步应用

目的经腹膜后入路的腹腔镜手术在泌尿外科已经被广泛采用,随着单孔腹腔镜技术的兴起,经腹膜后入路的单孔腹腔镜技术逐渐得到临床应用,本研究在于探讨单孔腹腔镜在腹膜后手术种的应用价值,评估其安全性。方法从2010年6月至2010年12月,15例患者接受经腹膜后入路单孔腹腔镜手术,其中包括单孔腹腔镜下肾部分切除术2例、肾上腺肿瘤切除术5例、肾囊肿去顶术5例与输尿管结石切开取石术3例。结果所有手术均在单孔下完成,无中转传统腹腔镜或开放手术,术中及术后无并发症发生。结论经腹膜后入路单孔腹腔镜手术安全可靠,具有临床应用价值。