中国近21年成人腹膜后淋巴管瘤流行病学特征及诊治经验

发布时间：2018-05-17 00:19

本文选题：成人 + 腹膜后　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:探讨中国近21年成人腹膜后淋巴管瘤流行病学特征及诊治经验。方法:联合检索中国知网、万方、维普等多家中文数据库有关成人腹膜后淋巴管瘤的文献资料,应用回顾性分析的方法分析成人腹膜后淋巴管瘤的流行强度、时间分布、空间分布、人群分布、临床特点、诊疗及预后转归等。结果:中国近21年(1995年1月-2015年12月)共报道92篇221例成人腹膜后淋巴管瘤。文献篇数及报道例数均逐年增加。性别比例(男:女)为1:1.03。所报道年龄最大者73岁(以最小年龄为18岁),发病年龄多集中在30-50岁之间,平均年龄约为41.55岁。地区分布前三依次为华东(29.41%)、华北(23.53%)、东北地区(14.48%),华南地区病例分布最少(6.79%),而发病率最高的地区为东北(1/342.25万人)、华北(1/361.97万人),西南地区发病率最低(1:/1206.11万人)。本病早期多无明显症状,肿瘤体积较大时会出现腹部症状。本组中因腹痛腹胀就诊的占32.58%(72/221),因查体发现肿物就诊的占25.79%(57/221),因触及包块就诊的占20.82%(46/221),以急腹症为主要表现而就诊时误诊较多,误诊以肾脏囊肿、卵巢囊肿、胰腺囊肿、阑尾炎等多见。超声及CT平扫被广泛用于术前诊断,其中197例(197/221,89.14%)有超声报道,180例(180/221,81.45%)有CT平扫报道,增强CT及MRI对于术前确诊腹膜后淋巴管瘤意义重大,是同其他腹膜后肿瘤鉴别诊断的有效手段,但本组病例中伴增强CT及MRI的报道并不常见。本病的影像学表现为肿瘤呈囊性、低密度(回声),边界较清晰,病变可呈单房(囊)及多房(囊),以后者多见,单多房(囊)之比为1:2.64,多房(囊)病变者可见囊内条带状分隔,分隔区影像学检查显示稍高密度(回声),肿瘤沿腹膜后的解剖、脏器间隙呈“延展性生长”是本病特征性的影像学表现。本组病例报道肿瘤大小不一,最小者3.5x2.6x1.8cm,最大者50x40x40cm,多集中在10cm-20cm之间。囊液多呈清亮淡黄色(53.66%,44/82)及乳糜样(35.37%,29/82),容量不一,最少者300ml,最多达20000ml。221例患者报道仅1名女性化验CA125升高,余200例均无肿瘤标记物异常报道。共有178例有病理结果,最多者囊性淋巴管瘤151例(84.83%),其次为海绵状淋巴管瘤12例(6.74%)。手术切除是治疗该病的主要手段,仅1例患者行非手术治疗(超声穿刺引流加腔内平阳霉素注射),手术术式多选择完整囊壁切除,无法完整切除的可给予电刀烧灼及3%-5%碘酊涂抹囊壁。肿瘤切除后预后较好,2例出现复发(行囊壁部分切除),分别于术后5月、1年复发,总复发率为0.90%(2/221)。所有病例均未出现死亡报道。结论:成人腹膜后淋巴管瘤较为罕见,本组资料性别比例为1:1.03(男:女),腹痛、腹胀为临床主要就诊原因,超声、CT为主要术前检查手段,增强CT可帮助确诊,肿瘤沿间隙“延展性”生长是其特殊的影像学表现,本病确诊依靠术后病理,囊性淋巴管瘤为最常见病理类型,手术切除是治疗该病的主要手段,肿瘤根治性切除后无复发。
[Abstract]:Objective: to investigate the epidemiological characteristics, diagnosis and treatment of retroperitoneal lymphangioma in Chinese adults in recent 21 years. Methods: the literature data of adult retroperitoneal lymphangioma were retrieved from the Chinese databases of Zhiwang, Wanfang and Weipu. The epidemic intensity and time distribution of adult retroperitoneal lymphangioma were analyzed by retrospective analysis. Spatial distribution, population distribution, clinical characteristics, diagnosis and treatment, prognosis and so on. Results: a total of 92 cases of retroperitoneal lymphangioma were reported from January 1995 to December 2015 in China. The number of articles and reported cases increased year by year. The sex ratio (M: F) is 1: 1.03. The oldest reported age was 73 years (the youngest was 18 years old), and the onset age was mostly between 30 and 50 years old, with an average age of 41.55 years. The first three regions in order are East China (29.41), North China (23.53), Northeast China (14.48%), South China (6.79%), and Northeast China (1.34225 000), North China (1 / 3.619 7 million), Southwest China (1 / 1 06.11 million). There are no obvious symptoms in the early stage of the disease, and abdominal symptoms will occur when the tumor is larger. In this group, patients with abdominal pain and abdominal distension accounted for 32.58% of 72 / 221g, 25.79g / 221g for diseases found by physical examination, 20.82% / 221% for patients with abdominal distension and 20.82% / 221% for patients with abdominal distension. Most of them were misdiagnosed as renal cysts, ovarian cysts, pancreatic cysts, and acute abdominal diseases, and most of them were misdiagnosed as renal cysts, ovarian cysts, pancreatic cysts. Appendicitis is more common. Ultrasound and CT plain scan were widely used in preoperative diagnosis, of which 197 cases (197 / 221 / 89.14) were reported by ultrasound (180 / 180 / 221 / 81.45). Enhanced CT and MRI were of great significance in the diagnosis of retroperitoneal lymphangioma before operation. It is an effective method for differential diagnosis with other retroperitoneal tumors, but the reports of enhanced CT and MRI are not common in this group. The imaging manifestations of the disease were cystic tumor, low density (echo, clear boundary), single locular (cystic) and multilocular (cystoma), the ratio of multilocular (cystic) was 1: 2.64, and in the case of multilocular (cystic) lesions, there was a band of compartmentalization in the capsule. The imaging examination of the septum showed a slightly high density (echo, tumor anatomy along the retroperitoneal area, and "ductile growth" of the space between organs), which was the characteristic imaging manifestation of the disease. The size of tumor was different, the smallest was 3.5x2.6x1.8cm, the largest was 50x40x40cm, and most of them were between 10cm-20cm. Most of the sac fluid showed bright yellowish yellow 53.66% (44 / 82) and chyme (35.37%), with different volume (300ml at least). Only one woman was reported to have increased CA125 in most cases of 20000ml.221, and no abnormal tumor markers were reported in the remaining 200 cases. A total of 178 cases had pathological results. The most common cystic lymphangioma occurred in 151 cases (84.83%), followed by spongiform lymphangioma in 12 cases (6.74%). Surgical resection was the main method for the treatment of the disease. Only one patient underwent non-operative treatment (ultrasonic puncture and drainage plus intracavitary pingyangmycin injection). Not completely resectable can be given electric knife cauterization and 3-5% iodine tincture smear the wall of the capsule. The prognosis of 2 cases was better after resection (partial resection of cyst wall was performed, respectively, 5 months after operation, 1 year after operation, the total recurrence rate was 0.90 / 221). No death was reported in all cases. Conclusion: retroperitoneal lymphangioma is rare in adults. The sex ratio of this group is 1: 1.03 (male: female, abdominal pain, abdominal distension are the main causes of clinical visit, ultrasound CT is the main means of preoperative examination, enhanced CT can help to diagnose the diagnosis. The "extension" of tumor along the space is its special imaging manifestation. The diagnosis of this disease depends on postoperative pathology. Cystic lymphangioma is the most common pathological type. Surgical resection is the main method for the treatment of the disease, and there is no recurrence after radical resection of the tumor.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.4

【参考文献】