63例原发性腹膜后肿瘤的诊断和外科治疗

目的 总结原发性腹膜后肿瘤诊断和外科治疗经验.方法 回顾性分析1990年1月至2007年3月63例经手术治疗且病理证实的原发性腹膜后肿瘤的临床表现、手术治疗、病理类型和随访结果.结果 63例中良性25例,恶性38例.主要临床表现为腹部包块,CT对良恶性判断的约登指数为85%,良性肿瘤完整切除率为88%,恶性肿瘤为68%,联合脏器切除占肿瘤完整切除总数的40%.肿瘤切除程度和病理类型与术后复发密切相关.良、恶性肿瘤完整切除的5年生存率分别为83.6%和27.3%.恶性肿瘤完整切除的患者平均随访36个月(5～168个月),53%局部复发,平均复发时间25个月(3～108个月),恶性肿瘤局部复发再手术完整切除率62.5%.全组有1例术后第1天腹腔内出血死亡.结论 应当重视临床表现争取早期诊断;影像学检查是判断手术范围的重要依据;肿瘤完整切除,必要时联合脏器切除是治疗本病的最佳手段;术后规律复查有助于及早发现复发肿瘤并争取再手术治疗.

Diagnosis and surgical treatment of primary retroperitoneal tumors: report of 63 cases

Objective To evaluate the experience in the diagnosis and surgical treatment of primary retroperitoneal tumor (PRT). Methods Clinical data of PRT 63 cases from January 1990 to March 2007 confirmed by pathology were retrospectively analyzed including clinical manifestation, surgical procedures, pathological examination and follow-up. Results Tumors were benign in 25 patients and malignant in 38. The main symptoms and signs were abdominal mass. The Youdon's index of CT examination for distinguishing benign from malignant tumors was 85%. The complete surgical resection rate was 88% for benign tumors and 68% for malignances. Removal of the involved organs or vessels was needed in 40% patients in complete surgical resection group. Postoperative recurrence was high in those the tumor was not completely removed and those the tumor was malignant. The 5-year survival rate for complete surgical resection of benign tumors was 83.6% ,and that of malignant tumors was 27.3%. After a median follow-up of 36 months (range 5 ～ 168)for the resection of malignant tumors, the local recurrence rate was 53%. Median time between initial surgery and recurrence was 25 months (range 3 ～ 108). For local recurrence of malignant tumor, the complete surgical resection rate was 62.5%. One patient died of intraabdominal hemorrhage in the first day after operation. Conclusion For PRT patients, early diagnosis is often difficult. Preoperative imaging results are essential to predict the surgical resectability. The optimal treatment of patients with PRT is radical resection, an bloc organ resection if necessary. Regularly postoperative follow-up is mandatory for early finding recurrence.