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[原发性腹膜后神经源性肿瘤的诊断与外科治疗]

[Diagnosis and surgical therapy of primary retroperitoneal neurogenic tumors].

作者信息

Xia Shao-You, Li Rong, Song Shao-Bai, Liang Fa-Qi

机构信息

Department of General Surgery, General Hospital of PLA, Beijing 100853, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2009 Jun 9;89(22):1567-9.

Abstract

OBJECTIVE

To explore the diagnosis and surgical therapy for retroperitoneal neurogenic tumors (PRNTs).

METHODS

The clinical records of 79 surgically treated patients with retroperitoneal neurogenic tumor were retrospectively analyzed.

RESULTS

Twenty-nine patients presented with abdominal pain, 26 with abdominal mass, 15 with inferior extremities pain and numbness and 9 patients without clinical symptoms. Type B ultrasound (BUS), CT scan and surgical resection were performed for all the patients. Pathological analysis identified 19 patients with neurofibroma, 8 with neurilemmoma, 4 with paraganglioma, 21 with neurofibrosarcoma, 14 with malignant neurilemmoma, 6 with malignant paraganglioma, 5 with neuroectodermal tumor and 2 with neuroblastoma. The mortality rate of PRNT operation is was 1.3%, 3-year recurrence rate of benign tumor 0%, 5-year recurrence rate of benign tumor 12.9%, reoperation rate 100%, 5-year survival rate 100%. 3 years recurrence rate of malignancy tumor 41.6%, reoperation rate 90%, 5 years recurrence rate of malignancy tumor 79.1% and 5 years survival rate is 62.5%.

CONCLUSION

BUS, CT and MRI are decisive for localization diagnosis. Surgical resection is the mainstay of therapy for this disease. Pre-operative preparation of intestinal tract and blood, maintaining the intactness of involved nerve are important for tumor resection. To prevent tumor recurrence, the key surgical techniques are to minimize tumor residues and . to handle intervertebral foramen properly.

摘要

目的

探讨腹膜后神经源性肿瘤(PRNTs)的诊断及外科治疗方法。

方法

回顾性分析79例接受手术治疗的腹膜后神经源性肿瘤患者的临床资料。

结果

29例患者表现为腹痛,26例表现为腹部肿块,15例表现为下肢疼痛和麻木,9例无临床症状。所有患者均行B型超声(BUS)、CT扫描及手术切除。病理分析显示,神经纤维瘤19例,神经鞘瘤8例,副神经节瘤4例,神经纤维肉瘤21例,恶性神经鞘瘤14例,恶性副神经节瘤6例,神经外胚层肿瘤5例,神经母细胞瘤2例。PRNT手术死亡率为1.3%,良性肿瘤3年复发率为0%,5年复发率为12.9%,再次手术率为100%,5年生存率为100%。恶性肿瘤3年复发率为41.6%,再次手术率为90%,5年复发率为79.1%,5年生存率为62.5%。

结论

BUS、CT和MRI对定位诊断起决定性作用。手术切除是本病治疗的主要方法。术前肠道和血液准备、保持受累神经的完整性对肿瘤切除很重要。为防止肿瘤复发,关键手术技术是尽量减少肿瘤残留并妥善处理椎间孔。

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