本文選題：腹部副神經(jīng)節(jié)腫瘤 + 功能性腫瘤��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:探討原發(fā)性腹部副神經(jīng)節(jié)瘤的臨床特征,總結(jié)診療經(jīng)驗(yàn)及分析預(yù)后。資料與方法:回顧性分析青島大學(xué)附屬醫(yī)院2001年12月至2016年12月期間手術(shù)治療的81例原發(fā)性腹部副神經(jīng)節(jié)瘤患者的臨床資料。結(jié)果:81例患者中有92.6%(75/81)的腫瘤位于腹膜后大血管旁;功能性、非功能性分別占53.0%(43/81)、47.0%(38/81),良性、惡性分別為79.0%(64/81)、21.0%(17/81);完全切除率為98.8%(80/81),有32.1%(26/81)為聯(lián)合器官切除;21.0%(17/81)的患者術(shù)中有劇烈血壓波動(dòng),6.2%(5/81)發(fā)生腫瘤切除后低血壓;總體3年、5年生存率分別為100%、92.0%,總體3年、5年復(fù)發(fā)率分別為2.0%、9.0%。功能性與非功能性良惡患病無(wú)差異(c2=0.31,P=0.580),術(shù)前無(wú)高血壓的功能性腫瘤患者術(shù)中發(fā)生血壓波動(dòng)的可能性更大(c2=28.50,P=0.000),腫瘤切除后低血壓發(fā)生率較高(c2=13.05,P=0.000);術(shù)前規(guī)律服用酚芐明可明顯降低術(shù)中血壓波動(dòng)的發(fā)生率(P=0.005)。腫瘤的功能狀態(tài)與浸潤(rùn)性無(wú)差異(c2=1.79,P=0.181);功能性腫瘤患者的3年、5年生存率分別為100%、96.0%,3年、5年復(fù)發(fā)率分別為0.0%、9.0%,非功能性腫瘤患者的3年、5年生存率分別為100.0%、86.0%,3年、5年復(fù)發(fā)率分別為5.0%、15.0%;功能性腫瘤患者近期預(yù)后好于非功能性腫瘤患者,而遠(yuǎn)期沒(méi)有差異(Log-Rank檢驗(yàn):c2=3.793,p=0.051,Breslow檢驗(yàn):c2=4.25,P=0.039),功能性腫瘤無(wú)瘤生存較好(Log-Rank檢驗(yàn):c2=4.24,p=0.039),非功能性腫瘤易復(fù)發(fā)(c2=4.256,P=0.039)。術(shù)前高血壓與血漿NE、E含量正相關(guān)(t=-3.86,P=0.001)、(t=-3.72,P=0.001),患者術(shù)后血漿NE、E含量較術(shù)前血漿NE、E含量降低(t=-4.36,P=0.000)、(t=2.24,P=0.041)。惡性腫瘤ki67較良性腫瘤ki67明顯高表達(dá)(Z=-6.34,P=0.000),惡性腫瘤囊性變率高(c2(17)=22.09,P=0.000);惡性腫瘤患者的3年、5年生存率分別為100%、66.0%,3年、5年復(fù)發(fā)率分別為6.0%、47.0%,良性腫瘤患者的3年、5年生存率分別為100.0%、96.0%,3年、5年復(fù)發(fā)率分別為0.0%、4.0%;良性腫瘤患者預(yù)后良好,惡性預(yù)后較差(Log-Rank檢驗(yàn):c2=18.053,P=000)。腫瘤單純切除(P=0.0498)是惡性腫瘤復(fù)發(fā)的危險(xiǎn)因素,腫瘤單純切除(c2=0.051,P=0.025)、無(wú)功能腫瘤(c2=3.996,P=0.046)是惡性腫瘤預(yù)后不良因素;經(jīng)多因素分析:腫瘤單純切除(P=0.043)是影響惡性腫瘤預(yù)后的顯著危險(xiǎn)因素。結(jié)論:副神經(jīng)節(jié)瘤多發(fā)生于腹膜后大血管旁,術(shù)中常發(fā)生血壓波動(dòng);無(wú)高血壓的功能性腫瘤患者術(shù)中容易發(fā)生血壓波動(dòng)及腫瘤切除后低血壓;血漿NE及E對(duì)判斷腫瘤功能狀態(tài)及手術(shù)效果有重要意義。雖然良惡性腫瘤無(wú)明確的組織病理診斷標(biāo)準(zhǔn),但Ki-67值及腫瘤囊性變對(duì)判斷腫瘤的良惡性有重要的提示作用。良性腫瘤患者預(yù)后較好,惡性腫瘤預(yù)后較差;功能性腫瘤預(yù)后好于非功能性腫瘤。腫瘤單純切除是惡性腫瘤復(fù)發(fā)、預(yù)后不良因素,所以術(shù)中根據(jù)腫瘤浸潤(rùn)情況,盡量做到擴(kuò)大切除。充分的術(shù)前準(zhǔn)備是手術(shù)成功的關(guān)鍵,對(duì)于無(wú)高血壓患者術(shù)前也應(yīng)該充分補(bǔ)液及服用酚芐明;術(shù)后應(yīng)當(dāng)終身隨訪,尤其是對(duì)于非功能性腫瘤及惡性患者。
[Abstract]:Objective: to investigate the clinical features of primary abdominal paraganglioma, summarize the experience of diagnosis and treatment and analyze the prognosis. Materials and methods: the clinical data of 81 patients with primary abdominal paraganglioma treated surgically from December 2001 to December 2016 in the affiliated Hospital of Qingdao University were retrospectively analyzed. Results of the 81 patients, 92.6% of the tumors were located next to the retroperitoneal great blood vessels, while the functional and non-functional ones accounted for 47.0% of the 47.0% of the tumors, which were benign. The total resection rate was 98.880% / 81%, and the total resection rate was 98.880% / 81% (32.1% 26 / 81). The patients with malignant tumor had severe blood pressure fluctuation (6.25.81%) after resection. The overall 3-year survival rate was 100% 92.0%, the overall 3-year survival rate was 92.0%, the overall recurrence rate was 2.09.0% in 5 years, and the recurrence rate was 2.09.0% in 5 years. There was no difference between functional and nonfunctional benign and malignant diseases. The possibility of blood pressure fluctuation in functional tumor patients without hypertension before operation was higher than that in non-functional tumor patients. The incidence of hypotension after tumor resection was higher than that of non-functional benign tumor patients. The incidence of intraoperative blood pressure fluctuation was significantly decreased (P < 0. 005). The 3-year survival rate of functional tumor patients was 100 ~ 96.0, the recurrence rate of 3 years and 5-year recurrence was 0.09.0 respectively, the 3-year survival rate of non-functional tumor patients was 100.00.00.The 5-year recurrence rate was 100.00.The 5-year survival rate of functional tumor patients was 100.00.The 5-year survival rate of patients with functional tumor was 100.00.The 5-year survival rate of functional tumor patients was 100 ~ 96.0, and the recurrence rate of 3 years and 5 years was 0.09.0.The 3-year survival rate of non-functional tumor patients was 100.00.The 5-year survival rate was 100.0%. The short-term prognosis of patients with functional tumors was better than that of patients with non-functional tumors. However, there was no difference in the long term between the two groups. There was no significant difference between the two groups in the long term, and there was no significant difference between the two groups in the long term. The proportion of non-functional tumors was 3.793p0.051and the Breslow test showed that the functional tumors had better survival without tumor. There was a positive correlation between preoperative hypertension and plasma NEI E content. The plasma NEE content in patients with hypertension was significantly lower than that in preoperative plasma NEE. The plasma NEE level was 2.24P0.041, 2.24P0.041. The expression of ki67 in malignant tumor was significantly higher than that in benign tumor. The rate of cystic change of malignant tumor was higher than that of benign tumor. The 3-year and 5-year survival rates of malignant tumor patients were 66.0, 3- and 5-year, respectively. The 3-year survival rate and 5-year survival rate of benign tumor patients were 6.047.00.The 3-year survival rate of benign tumor patients was higher than that of benign tumor patients. The 5-year survival rate of malignant tumor patients was 6.047.00.The 3-year survival rate of malignant tumor patients was 6.047.00.The 5-year survival rate of malignant tumor patients was 6.047.00. The recurrence rate for 3 years and 5 years was 0.00.The prognosis of benign tumor patients was good. The malignant prognosis was poor. Tumor resection alone (P0. 0498) is a risk factor for the recurrence of malignant tumor. Tumor resection alone is a significant risk factor for the prognosis of malignant tumors, while a simple excision of c2n (0. 051) and a nonfunctional tumor (3. 996P0. 046) is a significant risk factor for the prognosis of malignant neoplasms, and multivariate analysis shows that simple resection of the tumor (P0. 043) is a significant risk factor for the prognosis of malignant tumors. Conclusion: paraganglioma usually occurs near the retroperitoneal great blood vessel, and blood pressure fluctuates frequently during operation, and the patients with functional tumor without hypertension are prone to blood pressure fluctuation and hypotension after tumor resection. Plasma NE and E play an important role in judging tumor function and surgical effect. Although there is no definite histopathological diagnostic criteria for benign and malignant tumors, Ki-67 and cystic degeneration are important indicators for the diagnosis of benign and malignant tumors. The prognosis of benign tumors is better than that of malignant tumors, and the prognosis of functional tumors is better than that of non-functional tumors. Tumor resection alone is a factor of malignant tumor recurrence and poor prognosis. Adequate preoperative preparation is the key to the success of the operation. For patients without hypertension, adequate rehydration and administration of phenoprim should be performed before the operation, and postoperative follow-up should be carried out for life, especially in patients with non-functional tumors and malignant tumors.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R736.6

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