腹膜后神经鞘瘤82例临床分析

目的通过临床病例分析,了解腹膜后神经鞘瘤的临床诊治状况,提高鉴别诊断能力.方法对本组病例行临床分析.结果本组82例均行手术治疗,肿瘤全切除60例(占73.2%),次全和大部分切除13例(占15.9%),无法切除9例(占11.0%);术中探查单发肿瘤78例(占95.1%),多发4例(占4.9%).肿瘤多位于脊柱旁,呈囊实性,有包膜,表面光滑,血管丰富,界清,包膜表面可与周围组织粘连.病理结果诊为神经鞘瘤81例(占98.8%),恶性神经鞘瘤1例(占1.2%);在多发肿瘤4例中,2例(占2.4%)诊为双原发,伴随病灶为升结肠腺癌及左上肺鳞癌,术后复发1例.结论腹膜后神经鞘瘤发病率低,术前诊断困难,绝大部分为良性,恶性少见,主要治疗方法为手术治疗,恶性神经鞘瘤对放化疗不敏感,预后差.

Analysis of 82 cases of retroperitoneal schwannoma

Objective To analyze the clinical manifestations of retroperitoneal schwannoma in order to improve the diagnosis and treatment of this rare diseases.Methods Between January 1951 and September 2004,82 patients with retroperitoneal schwannoma were treated.Thirty-eight were men and 44 women of ages 0.5-70 years.The course of their disease ranged from ten days to two years with a tumor size of 4-21 cm in diameter.The chief symptoms were abdominal pain and bulge(17 cases,20.7%),abdominal discomfort(25 cases,30.5%).Sixteen patients(19.5%) found the tumor themselves without symptoms.Physical examination: palpable mass at the corresponding areas.The mass was often cystoid,solid,smooth and immovable.All 82 cases were retrospectively analyzed.Results All cases received operative therapy.Sixty cases(73.2%) received a total resection;13 cases(15.9%),subtotal resection;9 cases((11.0%)),exploration.During surgery,a single tumor was found in 78 cases(95.1%),and multiple tumors in 4 cases((4.9%)).Most of the retroperitoneal schwannomas were near the spine,and in form of fusiform,round or oval masses which were sharply circumscribed and encapsulated.Pathologic results showed that 81 cases(98.8%) were schwannoma and one case(1.2%)was malignant schwannoma.In the four multiple tumor cases,two((2.4%)) were double primary tumors which were ascending colon adenocarcinoma and lung squamous-cell cancer.One case recurred postoperatively.Conclusions Most of the retroperitoneal schwannomas were benign.It is difficult to confirm an accurate preoperative diagnosis.Treatment mainly depends on surgery.Because of the encapsulated nature of schwannoma,enucleation is recommended at operation,the dissection during operation is often carried out immediately surrounding the tumor capsule.The malignant tumor was insensitive to chemical treatment and radiation,resulting in poor prognosis.