Objective To investigate the clinical diagnosis and treatment strategies for retroperitoneal paragangliomas and to enhance the diag?nostic 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 re?vealed paragangliomas in 17 patients. The positive rate of localization was 77.5%(31/40),96.0%(47/49),and 100%(10/10)using B?ultra?sound,computed tomography,and MRI respectively. Serum catecholamines were measured in 19 patients,of which 16 cases(84.2%)showed ele?vated levels. Results In our study,49 patients underwent open surgery,5 patients showed multiple tumors,and 56 tumors were found during sur?gery. 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 metas?tasis during the follow?up period. Conclusion Surgical resection might be the most effective method for treatment of retroperitoneal paraganglio?mas. Sufficient preoperative and perioperative management might be the key point of successful surgery. Lifelong follow?up is important as recur?rent tumors need resection.%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.
展开▼
