81例腹部副神经节瘤的诊疗分析

发布时间：2018-06-03 00:18

本文选题：腹部副神经节肿瘤 + 功能性肿瘤　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:探讨原发性腹部副神经节瘤的临床特征,总结诊疗经验及分析预后。资料与方法:回顾性分析青岛大学附属医院2001年12月至2016年12月期间手术治疗的81例原发性腹部副神经节瘤患者的临床资料。结果:81例患者中有92.6%(75/81)的肿瘤位于腹膜后大血管旁;功能性、非功能性分别占53.0%(43/81)、47.0%(38/81),良性、恶性分别为79.0%(64/81)、21.0%(17/81);完全切除率为98.8%(80/81),有32.1%(26/81)为联合器官切除;21.0%(17/81)的患者术中有剧烈血压波动,6.2%(5/81)发生肿瘤切除后低血压;总体3年、5年生存率分别为100%、92.0%,总体3年、5年复发率分别为2.0%、9.0%。功能性与非功能性良恶患病无差异(c2=0.31,P=0.580),术前无高血压的功能性肿瘤患者术中发生血压波动的可能性更大(c2=28.50,P=0.000),肿瘤切除后低血压发生率较高(c2=13.05,P=0.000);术前规律服用酚苄明可明显降低术中血压波动的发生率(P=0.005)。肿瘤的功能状态与浸润性无差异(c2=1.79,P=0.181);功能性肿瘤患者的3年、5年生存率分别为100%、96.0%,3年、5年复发率分别为0.0%、9.0%,非功能性肿瘤患者的3年、5年生存率分别为100.0%、86.0%,3年、5年复发率分别为5.0%、15.0%;功能性肿瘤患者近期预后好于非功能性肿瘤患者,而远期没有差异(Log-Rank检验:c2=3.793,p=0.051,Breslow检验:c2=4.25,P=0.039),功能性肿瘤无瘤生存较好(Log-Rank检验:c2=4.24,p=0.039),非功能性肿瘤易复发(c2=4.256,P=0.039)。术前高血压与血浆NE、E含量正相关(t=-3.86,P=0.001)、(t=-3.72,P=0.001),患者术后血浆NE、E含量较术前血浆NE、E含量降低(t=-4.36,P=0.000)、(t=2.24,P=0.041)。恶性肿瘤ki67较良性肿瘤ki67明显高表达(Z=-6.34,P=0.000),恶性肿瘤囊性变率高(c2(17)=22.09,P=0.000);恶性肿瘤患者的3年、5年生存率分别为100%、66.0%,3年、5年复发率分别为6.0%、47.0%,良性肿瘤患者的3年、5年生存率分别为100.0%、96.0%,3年、5年复发率分别为0.0%、4.0%;良性肿瘤患者预后良好,恶性预后较差(Log-Rank检验:c2=18.053,P=000)。肿瘤单纯切除(P=0.0498)是恶性肿瘤复发的危险因素,肿瘤单纯切除(c2=0.051,P=0.025)、无功能肿瘤(c2=3.996,P=0.046)是恶性肿瘤预后不良因素;经多因素分析:肿瘤单纯切除(P=0.043)是影响恶性肿瘤预后的显著危险因素。结论:副神经节瘤多发生于腹膜后大血管旁,术中常发生血压波动;无高血压的功能性肿瘤患者术中容易发生血压波动及肿瘤切除后低血压;血浆NE及E对判断肿瘤功能状态及手术效果有重要意义。虽然良恶性肿瘤无明确的组织病理诊断标准,但Ki-67值及肿瘤囊性变对判断肿瘤的良恶性有重要的提示作用。良性肿瘤患者预后较好,恶性肿瘤预后较差;功能性肿瘤预后好于非功能性肿瘤。肿瘤单纯切除是恶性肿瘤复发、预后不良因素,所以术中根据肿瘤浸润情况,尽量做到扩大切除。充分的术前准备是手术成功的关键,对于无高血压患者术前也应该充分补液及服用酚苄明;术后应当终身随访,尤其是对于非功能性肿瘤及恶性患者。
[Abstract]:Objective: to investigate the clinical features of primary abdominal paraganglioma, summarize the experience of diagnosis and treatment and analyze the prognosis. Materials and methods: the clinical data of 81 patients with primary abdominal paraganglioma treated surgically from December 2001 to December 2016 in the affiliated Hospital of Qingdao University were retrospectively analyzed. Results of the 81 patients, 92.6% of the tumors were located next to the retroperitoneal great blood vessels, while the functional and non-functional ones accounted for 47.0% of the 47.0% of the tumors, which were benign. The total resection rate was 98.880% / 81%, and the total resection rate was 98.880% / 81% (32.1% 26 / 81). The patients with malignant tumor had severe blood pressure fluctuation (6.25.81%) after resection. The overall 3-year survival rate was 100% 92.0%, the overall 3-year survival rate was 92.0%, the overall recurrence rate was 2.09.0% in 5 years, and the recurrence rate was 2.09.0% in 5 years. There was no difference between functional and nonfunctional benign and malignant diseases. The possibility of blood pressure fluctuation in functional tumor patients without hypertension before operation was higher than that in non-functional tumor patients. The incidence of hypotension after tumor resection was higher than that of non-functional benign tumor patients. The incidence of intraoperative blood pressure fluctuation was significantly decreased (P < 0. 005). The 3-year survival rate of functional tumor patients was 100 ~ 96.0, the recurrence rate of 3 years and 5-year recurrence was 0.09.0 respectively, the 3-year survival rate of non-functional tumor patients was 100.00.00.The 5-year recurrence rate was 100.00.The 5-year survival rate of functional tumor patients was 100.00.The 5-year survival rate of patients with functional tumor was 100.00.The 5-year survival rate of functional tumor patients was 100 ~ 96.0, and the recurrence rate of 3 years and 5 years was 0.09.0.The 3-year survival rate of non-functional tumor patients was 100.00.The 5-year survival rate was 100.0%. The short-term prognosis of patients with functional tumors was better than that of patients with non-functional tumors. However, there was no difference in the long term between the two groups. There was no significant difference between the two groups in the long term, and there was no significant difference between the two groups in the long term. The proportion of non-functional tumors was 3.793p0.051and the Breslow test showed that the functional tumors had better survival without tumor. There was a positive correlation between preoperative hypertension and plasma NEI E content. The plasma NEE content in patients with hypertension was significantly lower than that in preoperative plasma NEE. The plasma NEE level was 2.24P0.041, 2.24P0.041. The expression of ki67 in malignant tumor was significantly higher than that in benign tumor. The rate of cystic change of malignant tumor was higher than that of benign tumor. The 3-year and 5-year survival rates of malignant tumor patients were 66.0, 3- and 5-year, respectively. The 3-year survival rate and 5-year survival rate of benign tumor patients were 6.047.00.The 3-year survival rate of benign tumor patients was higher than that of benign tumor patients. The 5-year survival rate of malignant tumor patients was 6.047.00.The 3-year survival rate of malignant tumor patients was 6.047.00.The 5-year survival rate of malignant tumor patients was 6.047.00. The recurrence rate for 3 years and 5 years was 0.00.The prognosis of benign tumor patients was good. The malignant prognosis was poor. Tumor resection alone (P0. 0498) is a risk factor for the recurrence of malignant tumor. Tumor resection alone is a significant risk factor for the prognosis of malignant tumors, while a simple excision of c2n (0. 051) and a nonfunctional tumor (3. 996P0. 046) is a significant risk factor for the prognosis of malignant neoplasms, and multivariate analysis shows that simple resection of the tumor (P0. 043) is a significant risk factor for the prognosis of malignant tumors. Conclusion: paraganglioma usually occurs near the retroperitoneal great blood vessel, and blood pressure fluctuates frequently during operation, and the patients with functional tumor without hypertension are prone to blood pressure fluctuation and hypotension after tumor resection. Plasma NE and E play an important role in judging tumor function and surgical effect. Although there is no definite histopathological diagnostic criteria for benign and malignant tumors, Ki-67 and cystic degeneration are important indicators for the diagnosis of benign and malignant tumors. The prognosis of benign tumors is better than that of malignant tumors, and the prognosis of functional tumors is better than that of non-functional tumors. Tumor resection alone is a factor of malignant tumor recurrence and poor prognosis. Adequate preoperative preparation is the key to the success of the operation. For patients without hypertension, adequate rehydration and administration of phenoprim should be performed before the operation, and postoperative follow-up should be carried out for life, especially in patients with non-functional tumors and malignant tumors.
【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】：R736.6

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