本文選題：成人 + 腹膜后��； 參考：《青島大學》2017年碩士論文

【摘要】：目的:探討中國近21年成人腹膜后淋巴管瘤流行病學特征及診治經(jīng)驗。方法:聯(lián)合檢索中國知網(wǎng)、萬方、維普等多家中文數(shù)據(jù)庫有關(guān)成人腹膜后淋巴管瘤的文獻資料,應用回顧性分析的方法分析成人腹膜后淋巴管瘤的流行強度、時間分布、空間分布、人群分布、臨床特點、診療及預后轉(zhuǎn)歸等。結(jié)果:中國近21年(1995年1月-2015年12月)共報道92篇221例成人腹膜后淋巴管瘤。文獻篇數(shù)及報道例數(shù)均逐年增加。性別比例(男:女)為1:1.03。所報道年齡最大者73歲(以最小年齡為18歲),發(fā)病年齡多集中在30-50歲之間,平均年齡約為41.55歲。地區(qū)分布前三依次為華東(29.41%)、華北(23.53%)、東北地區(qū)(14.48%),華南地區(qū)病例分布最少(6.79%),而發(fā)病率最高的地區(qū)為東北(1/342.25萬人)、華北(1/361.97萬人),西南地區(qū)發(fā)病率最低(1:/1206.11萬人)。本病早期多無明顯癥狀,腫瘤體積較大時會出現(xiàn)腹部癥狀。本組中因腹痛腹脹就診的占32.58%(72/221),因查體發(fā)現(xiàn)腫物就診的占25.79%(57/221),因觸及包塊就診的占20.82%(46/221),以急腹癥為主要表現(xiàn)而就診時誤診較多,誤診以腎臟囊腫、卵巢囊腫、胰腺囊腫、闌尾炎等多見。超聲及CT平掃被廣泛用于術(shù)前診斷,其中197例(197/221,89.14%)有超聲報道,180例(180/221,81.45%)有CT平掃報道,增強CT及MRI對于術(shù)前確診腹膜后淋巴管瘤意義重大,是同其他腹膜后腫瘤鑒別診斷的有效手段,但本組病例中伴增強CT及MRI的報道并不常見。本病的影像學表現(xiàn)為腫瘤呈囊性、低密度(回聲),邊界較清晰,病變可呈單房(囊)及多房(囊),以后者多見,單多房(囊)之比為1:2.64,多房(囊)病變者可見囊內(nèi)條帶狀分隔,分隔區(qū)影像學檢查顯示稍高密度(回聲),腫瘤沿腹膜后的解剖、臟器間隙呈“延展性生長”是本病特征性的影像學表現(xiàn)。本組病例報道腫瘤大小不一,最小者3.5x2.6x1.8cm,最大者50x40x40cm,多集中在10cm-20cm之間。囊液多呈清亮淡黃色(53.66%,44/82)及乳糜樣(35.37%,29/82),容量不一,最少者300ml,最多達20000ml。221例患者報道僅1名女性化驗CA125升高,余200例均無腫瘤標記物異常報道。共有178例有病理結(jié)果,最多者囊性淋巴管瘤151例(84.83%),其次為海綿狀淋巴管瘤12例(6.74%)。手術(shù)切除是治療該病的主要手段,僅1例患者行非手術(shù)治療(超聲穿刺引流加腔內(nèi)平陽霉素注射),手術(shù)術(shù)式多選擇完整囊壁切除,無法完整切除的可給予電刀燒灼及3%-5%碘酊涂抹囊壁。腫瘤切除后預后較好,2例出現(xiàn)復發(fā)(行囊壁部分切除),分別于術(shù)后5月、1年復發(fā),總復發(fā)率為0.90%(2/221)。所有病例均未出現(xiàn)死亡報道。結(jié)論:成人腹膜后淋巴管瘤較為罕見,本組資料性別比例為1:1.03(男:女),腹痛、腹脹為臨床主要就診原因,超聲、CT為主要術(shù)前檢查手段,增強CT可幫助確診,腫瘤沿間隙“延展性”生長是其特殊的影像學表現(xiàn),本病確診依靠術(shù)后病理,囊性淋巴管瘤為最常見病理類型,手術(shù)切除是治療該病的主要手段,腫瘤根治性切除后無復發(fā)。
[Abstract]:Objective: to investigate the epidemiological characteristics, diagnosis and treatment of retroperitoneal lymphangioma in Chinese adults in recent 21 years. Methods: the literature data of adult retroperitoneal lymphangioma were retrieved from the Chinese databases of Zhiwang, Wanfang and Weipu. The epidemic intensity and time distribution of adult retroperitoneal lymphangioma were analyzed by retrospective analysis. Spatial distribution, population distribution, clinical characteristics, diagnosis and treatment, prognosis and so on. Results: a total of 92 cases of retroperitoneal lymphangioma were reported from January 1995 to December 2015 in China. The number of articles and reported cases increased year by year. The sex ratio (M: F) is 1: 1.03. The oldest reported age was 73 years (the youngest was 18 years old), and the onset age was mostly between 30 and 50 years old, with an average age of 41.55 years. The first three regions in order are East China (29.41), North China (23.53), Northeast China (14.48%), South China (6.79%), and Northeast China (1.34225 000), North China (1 / 3.619 7 million), Southwest China (1 / 1 06.11 million). There are no obvious symptoms in the early stage of the disease, and abdominal symptoms will occur when the tumor is larger. In this group, patients with abdominal pain and abdominal distension accounted for 32.58% of 72 / 221g, 25.79g / 221g for diseases found by physical examination, 20.82% / 221% for patients with abdominal distension and 20.82% / 221% for patients with abdominal distension. Most of them were misdiagnosed as renal cysts, ovarian cysts, pancreatic cysts, and acute abdominal diseases, and most of them were misdiagnosed as renal cysts, ovarian cysts, pancreatic cysts. Appendicitis is more common. Ultrasound and CT plain scan were widely used in preoperative diagnosis, of which 197 cases (197 / 221 / 89.14) were reported by ultrasound (180 / 180 / 221 / 81.45). Enhanced CT and MRI were of great significance in the diagnosis of retroperitoneal lymphangioma before operation. It is an effective method for differential diagnosis with other retroperitoneal tumors, but the reports of enhanced CT and MRI are not common in this group. The imaging manifestations of the disease were cystic tumor, low density (echo, clear boundary), single locular (cystic) and multilocular (cystoma), the ratio of multilocular (cystic) was 1: 2.64, and in the case of multilocular (cystic) lesions, there was a band of compartmentalization in the capsule. The imaging examination of the septum showed a slightly high density (echo, tumor anatomy along the retroperitoneal area, and "ductile growth" of the space between organs), which was the characteristic imaging manifestation of the disease. The size of tumor was different, the smallest was 3.5x2.6x1.8cm, the largest was 50x40x40cm, and most of them were between 10cm-20cm. Most of the sac fluid showed bright yellowish yellow 53.66% (44 / 82) and chyme (35.37%), with different volume (300ml at least). Only one woman was reported to have increased CA125 in most cases of 20000ml.221, and no abnormal tumor markers were reported in the remaining 200 cases. A total of 178 cases had pathological results. The most common cystic lymphangioma occurred in 151 cases (84.83%), followed by spongiform lymphangioma in 12 cases (6.74%). Surgical resection was the main method for the treatment of the disease. Only one patient underwent non-operative treatment (ultrasonic puncture and drainage plus intracavitary pingyangmycin injection). Not completely resectable can be given electric knife cauterization and 3-5% iodine tincture smear the wall of the capsule. The prognosis of 2 cases was better after resection (partial resection of cyst wall was performed, respectively, 5 months after operation, 1 year after operation, the total recurrence rate was 0.90 / 221). No death was reported in all cases. Conclusion: retroperitoneal lymphangioma is rare in adults. The sex ratio of this group is 1: 1.03 (male: female, abdominal pain, abdominal distension are the main causes of clinical visit, ultrasound CT is the main means of preoperative examination, enhanced CT can help to diagnose the diagnosis. The "extension" of tumor along the space is its special imaging manifestation. The diagnosis of this disease depends on postoperative pathology. Cystic lymphangioma is the most common pathological type. Surgical resection is the main method for the treatment of the disease, and there is no recurrence after radical resection of the tumor.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.4

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