中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2017, Vol. 46 ›› Issue (5): 444-448.doi: 10.12007/j.issn.0258-4646.2017.05.015

• 论著 • 上一篇    下一篇

原发性腹膜后副神经节瘤的临床特点与诊断治疗策略

王世洋 1,杨野 1,张佳林 2   

  1. 中国医科大学附属第一医院 1 老年病综合外科,2 肝胆外科,沈阳 110001
  • 收稿日期:2017-03-06 出版日期:2017-05-30 发布日期:2017-05-18
  • 通讯作者: 杨野 E-mail:yycmugz@126.com
  • 作者简介:王世洋(1985 -),男,医师,硕士 .
  • 基金资助:
    沈阳市科学技术计划(F13?212?9?00)

Clinical Features of Retroperitoneal Paragangliomas and Strategies for Diagnosis and Treatment

WANG Shiyang1,YANG Ye1,ZHANG Jialin2   

  1. 1 Department of Geriatric Surgery,The First Hospital,China Medical University,Shenyang 110001,China;2 Department of Hepatobiliary Surgery,The First Hospital,China Medical University,Shenyang 110001,China
  • Received:2017-03-06 Online:2017-05-30 Published:2017-05-18

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。

关键词: 副神经节瘤, 腹膜后肿瘤, 诊断, 治疗

Abstract: Objective To investigate the clinical diagnosis and treatment strategies for retroperitoneal paragangliomas and to enhance the diagnostic and therapeutic levels of retroperitoneal paragangliomas. Methods The clinical data of 49 patients having retroperitoneal paragangliomas were retrospectively analyzed. We studied 21 males and 28 females between an age range 17 and 72 years(mean 45.6 years). Hypertension was observed in 19 patients,9 patients suffered from lumbago or abdominal pain,and an abdominal mass was noted in 2 cases. Physical examination revealed paragangliomas in 17 patients. The positive rate of localization was 77.5%(31/40),96.0%(47/49),and 100%(10/10)using B-ultrasound,computed tomography,and MRI respectively. Serum catecholamines were measured in 19 patients,of which 16 cases(84.2%)showed elevated levels. Results In our study,49 patients underwent open surgery,5 patients showed multiple tumors,and 56 tumors were found during surgery. The most common tumor location was periaortic and pericaval(71.4%,40/56). There were 51 cases of surgery in 49 patients. 54 tumors of 49 cases were totally resected. The tumors measured 1.5-20.0 cm in diameter with a mean diameter 6.7 cm. 75% tumors had integral pelos,14.2%(8/56)invaded the surrounding organs and vessels,and 10.7%(6/56)required resection of adjacent organs. We followed up 43 patients between 6 and 138 months after surgery. Postsurgical recurrence was noted in 4 patients,and 2 patients developed metastases. One patient died from metastasis during the follow-up period. Conclusion Surgical resection might be the most effective method for treatment of retroperitoneal paragangliomas. Sufficient preoperative and perioperative management might be the key point of successful surgery. Lifelong follow-up is important as recurrent tumors need resection.

Key words: paraganglioma, retroperitoneal tumor, diagnosis, surgery

中图分类号: 

  • R656.4
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