原发性腹膜后副神经节瘤的临床特点与诊断治疗策略

发布时间：2018-08-22 19:48

【摘要】：目的探讨原发性腹膜后副神经节瘤的临床特点、诊断方法、治疗策略,以提高腹膜后副神经节瘤的诊治水平。方法回顾性分析49例原发性腹膜后副神经节瘤患者的临床资料,患者就诊原因包括高血压(19例)、腰腹痛(9例)、腹部肿物(2例)、体检(17例)以及其他原因(2例)。超声检查的定位准确率为77.5%(31/40),CT检查的定位准确率为96.0%(47/49),MRI检查的定位准确率为100%(10/10)。19例术前高血压患者行血儿茶酚胺检查,阳性率84.2%(16/19)。结果 49例患者均行开放性手术,2例患者因肿瘤复发行二次手术,共行手术51例。肿瘤多发5例,术中共发现肿瘤56枚。71.4%(40/56)的肿瘤位于腹主动脉及下腔静脉周围。49例手术(94.1%,49/51)完整切除肿瘤54枚,切除肿瘤平均最大直径6.7 cm(1.5~20.0 cm),75%(42/56)的肿瘤包膜完整。8枚肿瘤呈浸润性生长,侵及周围脏器及重要血管。6例联合脏器切除。术后43例获随访6~138个月,90%的术前高血压患者术后血压恢复正常。复发4例,其中2例伴肿瘤远处转移且1例因肿瘤转移而死亡。结论腹膜后副神经节瘤最有效的治疗方式是手术治疗。完善的术前准备十分重要,关系着手术的成败及患者的预后情况。患者术后应长期随访,如果复查发现肿瘤复发,可行二次手术切除复发肿瘤。
[Abstract]:Objective to investigate the clinical features, diagnostic methods and treatment strategies of primary retroperitoneal paraganglioma in order to improve the diagnosis and treatment of retroperitoneal paraganglioma. Methods the clinical data of 49 patients with primary retroperitoneal paraganglioma were retrospectively analyzed. The causes included hypertension (19 cases), lumbar abdominal pain (9 cases), abdominal mass (2 cases), physical examination (17 cases) and other causes (2 cases). The localization accuracy of ultrasonography was 77.5% (31 / 40). The accuracy of CT was 96.0% (47 / 49). The accuracy of MRI was 100% (10 / 10). The positive rate was 84.2% (16 / 19). Results all 49 patients underwent open surgery. There were 5 cases of multiple tumors. During the operation, 56 tumors (40 / 56) were found to be located around the abdominal aorta and inferior vena cava in 49 cases (94. 1% 49 / 51). The mean maximum diameter of tumor was 6.7 cm (1.5 ~ 20.0 cm) and 75% (42 / 56) of tumor capsule. After operation, 43 patients with hypertension were followed up for 6 ~ 138 months, 90% of them had normal blood pressure after operation. 4 cases recurred, 2 cases with distant metastasis and 1 case died as a result of tumor metastasis. Conclusion Surgical treatment is the most effective treatment for retroperitoneal paraganglioma. Good preoperative preparation is very important, related to the success or failure of the operation and the prognosis of patients. The patients should be followed up for a long time. If the recurrence of tumor is found, it is feasible to resect the recurrent tumor with secondary operation.
【作者单位】：中国医科大学附属第一医院老年病综合外科;中国医科大学附属第一医院肝胆外科;
【基金】：沈阳市科学技术计划(F13-212-9-00)
【分类号】：R735.4

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