CAJ | 학술논문

目的探索原发性盆腔腹膜后肿瘤的诊断依据,总结其临床特点及治疗方法.方法收集1986年1月至2013年9月因盆腔占位性病变就诊于中国医学科学院北京协和医院的36例原发性盆腔腹膜后肿瘤患者的临床病理资料进行回顾性分析,对其临床表现、辅助检查、术中情况、术后病理检查、预后等情况进行总结.结果 36例原发性盆腔腹膜后肿瘤患者中,妇科首诊29例,外科首诊7例.只有7例患者发现肿瘤之前有腹胀等不适主诉.辅助检查:27例患者术前行B超检查,仅3例提示肿瘤位于腹膜后;行CT、MRI检查者的准确率相对较高,分别为16例中6例、6例中3例提示肿瘤位于腹膜后.18例患者术前行血清CA125水平检测,其中17例患者血清CA125水平正常或轻度升高.8例患者因肿瘤与周围血管或盆壁关系密切而未达到完全切除肿瘤,其余28例患者均达到完全切除肿瘤.25例在妇科接受手术治疗的患者中,10例患者术中请外科医师协助手术;2例术中并发泌尿系统损伤.术后病理检查:良性肿瘤28例(78％,28/36),包括神经鞘瘤11例、平滑肌瘤6例、畸胎瘤3例、血管淋巴管平滑肌瘤1例、神经纤维瘤1例、副神经节瘤1例、纤维瘤病2例、侵袭性血管黏液瘤1例、黏液性囊腺瘤1例、孤立性纤维性肿瘤1例;恶性肿瘤8例(22％,8/36),包括平滑肌肉瘤3例、脂肪肉瘤2例、腺癌2例、鳞癌1例.28例术中达到完全切除肿瘤的患者术后随访期内均未复发,而8例未达到完全切除肿瘤的患者中有3例复发.结论原发性盆腔腹膜后肿瘤的临床表现不典型,CT、MRI检查的准确率较高.手术是其主要的治疗方法,因盆腔腹膜后解剖结构复杂,手术困难,需多学科协作完成手术.
목적 탐색원발성분강복막후종류적진단의거,총결기림상특점급치료방법.방법 수집1986년1월지2013년9월인분강점위성병변취진우중국의학과학원북경협화의원적36례원발성분강복막후종류환자적림상병리자료진행회고성분석,대기림상표현、보조검사、술중정황、술후병리검사、예후등정황진행총결.결과 36례원발성분강복막후종류환자중,부과수진29례,외과수진7례.지유7례환자발현종류지전유복창등불괄주소.보조검사:27례환자술전행B초검사,부3례제시종류위우복막후;행CT、MRI검사자적준학솔상대교고,분별위16례중6례、6례중3례제시종류위우복막후.18례환자술전행혈청CA125수평검측,기중17례환자혈청CA125수평정상혹경도승고.8례환자인종류여주위혈관혹분벽관계밀절이미체도완전절제종류,기여28례환자균체도완전절제종류.25례재부과접수수술치료적환자중,10례환자술중청외과의사협조수술;2례술중병발비뇨계통손상.술후병리검사:량성종류28례(78％,28/36),포괄신경초류11례、평활기류6례、기태류3례、혈관림파관평활기류1례、신경섬유류1례、부신경절류1례、섬유류병2례、침습성혈관점액류1례、점액성낭선류1례、고립성섬유성종류1례;악성종류8례(22％,8/36),포괄평활기육류3례、지방육류2례、선암2례、린암1례.28례술중체도완전절제종류적환자술후수방기내균미복발,이8례미체도완전절제종류적환자중유3례복발.결론 원발성분강복막후종류적림상표현불전형,CT、MRI검사적준학솔교고.수술시기주요적치료방법,인분강복막후해부결구복잡,수술곤난,수다학과협작완성수술.
Objective To explorer the diagnostic rationales for primary pelvic retroperitoneal tumors and summarize their clinical characteristics and treatments.Methods The clinicopathological data of total of 36 patients with primary pelvic retroperitoneal tumor,who visited Peking Union Medical Collage Hospital,Chinese Academy of Medical Sciences because of pelvic mass from January 1986 and September 2013 were analysed retrospectively.And their clinical manifestations,accessory examination,surgical findings,postoperative pathological results and prognosis were summarized.Results Among the 36 patients,twenty-nine cases were treated by gynecology department firstly,7 cases were treated by surgical department firstly.Only 7 cases complained abdominal expanding while others had no uncomfortable complains before the discovery of the tumor.Among 27 cases who took color Doppler ultrasonography examination,only 3 cases reminded that the tumors might come from the pelvic retroperitoneal space.CT and MRI results were respectively 6/16 and 3/6,that the tumor might come from the pelvic retroperitoneal space.The level of CA125 of 18 cases were tested before the surgery:17 out of 18 cases were normal or elevated lightly.The tumors of 8 cases were excised incompletely because of the blood vessels around the tumors and the close relationship between the tumors and the pelvic wall,while other's were excised completely.Among the 25 cases that had operation at the gynecological department,ten cases underwent operations collaboratively with surgical department; two cases had complications of urinary system injures.Postoperative pathological examinations revealed there were 28 cases (78％,28/36)with benign lesions including 1 1 schwannoma,6 leiomyoma,3 teratoma,1 lymphangioleiomyoma,1 neurofibroma,1 paraganglioma,2 fibromatosis,1 aggressive angiomyxoma,1 mucinous cystadenoma and 1 solitary fibrous tumor; and 8 cases (22％,8/36)with malignant lesions including 3 leiomyosarcoma,2 liposarcoma,2 adenocarcinoma and 1 squamous carcinoma.During the follow-up period,28 cases whose tumors were excised completely had no recurrence.While,3 out of 8 cases excised incompletely recurred.Conclusions Primary pelvic retroperitoneal tumors have no typical manifestations,CT and MRI are more accurate.Surgery is a key for retroperitoneal tumors.Considering the complexity of the anatomy of the pelvic retroperitoneal space and the resulted difficulties of the surgeries,multidisiciplinary cooperation is needed and important.