Andronescu P, Ardelean M, Gradinaru V, Ene V
Clinica de Chirurgie N. Gh. Lupu, Bucureşti.
Chirurgia (Bucur). 1997 Jan-Feb;92(1):39-45.
Adult's retroperitoneal tumours of nervous origin are infrequent clinical entities with characteristic evolution and treatment. We review 13 cases, dealt with in N. Gh. Lupu Surgical Clinic between 1975-1994 and representing 20% of the retroperitoneal tumour admitted in our clinic during the same period. Most of the patients were males (sex ratio 10:3). The main symptom was the abdominal pain (84.6% of all cases) and all the tumours were extremely big (15-30 cm diameter). The surgical approach always tried to remove the tumour, which succeeded, even if in 4 cases some of the surrounding organs had to be removed also. The two postoperative complications consisted in a severe wound infection and an acute pancreatitis; the second evolved poorly and the patient was lost. No complementary therapy was used. None of the five patients followed up for five years presented clinical evidence of recurrent tumour.
Due to an unexplained evolutive tolerance, adult's retroperitoneal tumours of nervous origin reach large dimensions and have late clinical expression, as the complications occur. Preoperative imagistic findings supply valuable informations for the subsequent surgical treatment. The surgical approach must aim to the ablation of the tumour, with or without the sacrifice of other organs which the tumours can include. This aggressive surgical conduite is sustained by the satisfying postoperative results.
成人神经源性腹膜后肿瘤是临床少见的疾病,具有独特的发展过程和治疗方法。我们回顾了1975年至1994年间在N. Gh. Lupu外科诊所治疗的13例病例,占同期本诊所收治的腹膜后肿瘤的20%。大多数患者为男性(性别比为10:3)。主要症状为腹痛(占所有病例的84.6%),所有肿瘤都非常大(直径15 - 30厘米)。手术方法总是试图切除肿瘤,手术成功,即使在4例中还不得不切除一些周围器官。术后有两种并发症,即严重的伤口感染和急性胰腺炎;后者病情发展不佳,患者死亡。未采用辅助治疗。随访五年的五名患者均无肿瘤复发的临床证据。
由于一种无法解释的进展耐受性,成人神经源性腹膜后肿瘤体积较大,临床症状出现较晚,因为并发症会随之发生。术前影像学检查结果为后续手术治疗提供了有价值的信息。手术方法必须旨在切除肿瘤,无论是否牺牲肿瘤可能累及的其他器官。这种积极的手术方式因术后令人满意的结果而得到支持。