| Background Paraganglioma,also known as ectopic pheochromocytoma,refers to all pheochromocytomas that do not originate from adrenal tissue as paraganglioma,which is a rare neuroendocrine tumor.Paraganglioma is a tumor originating from the accessory ganglion,which is divided into the adrenal medulla paraganglionic ganglion distributed in the adrenal medulla and the extraadrenal paraganglionic ganglion mainly distributed in the paraspinal and para-aortic axis,which is closely related to the sympathetic nerve.Because paraganglioma is widely distributed,paraganglioma can occur in a wide range of areas from the skull base to the pelvic floor,and the naming of paraganglioma is also based on its location.Schwannoma is a kind of Schwann cell tumor originating from nerve sheath,which mainly occurs in the cranial nerve and peripheral nerve of the upper limb,but schwannoma is the most common retroperitoneal soft tissue tumor.Retroperitoneal paraganglioma and schwannoma both belong to retroperitoneal neurogenic tumor.because of their special endocrine function,early clinical symptoms of paraganglioma are related to excessive secretion of catecholamine.however,there are few patients with typical symptoms in clinical practice,and most patients have no characteristic clinical manifestations.Similarly,because the schwannoma develops slowly and the retroperitoneal space is composed of loose tissue,if the tumor does not originate from the spinal nerve root and other sites that can produce compression symptoms in the early stage,when the early tumor volume is small and does not produce pain,acute and severe compression symptoms,there is often no consciousness of seeing a doctor,and the tumor volume is already very large when there are obvious clinical manifestations.At present,surgical resection is the first choice for the treatment of these two kinds of neurogenic tumors,but the inability to determine the nature of the tumor before operation will greatly increase the uncertain factors in the operation,and even produce serious surgical complications or reoperation.Therefore,there is still a lot of research space for the preoperative diagnosis and intraoperative management of retroperitoneal neurogenic tumors.Objective By analyzing the clinical characteristics,treatment and survival characteristics of patients with primary retroperitoneal paraganglioma and schwannoma,the clinical characteristics and prognosis of primary retroperitoneal paraganglioma and schwannoma were discussed.In order to guide the choice of preoperative differential diagnosis and treatment of the two diseases.Methods A retrospective study was conducted on 40 patients with retroperitoneal paraganglioma and 32 patients with retroperitoneal schwannoma admitted to China-Japan Friendship Hospital of Jilin University from January 1,2010 to December 31,2018.the epidemiological characteristics(sex,age),clinical features,imaging manifestations,surgical methods,intraoperative conditions and prognosis were analyzed in combination with the existing literature.The data were analyzed by SPSS22.0 software,chi-square test was used for qualitative data,mean was used for measurement data of non-normal distribution,and Mann.Whitney U test was used for comparison between the two groups.The difference was statistically significant(P < 0.05).Results Retroperitoneal paraganglioma: a total of 40 patients were included,20 males and 20 females(20 stroke 40 50%).The ratio of male to female patients was 1%.The age of the patients ranged from 6 to 77 years old,with an average age of 46.83 ±15.69 years old.The proportion of patients in each department was hepatobiliary surgery(10gamma 40 college 25%),gastrointestinal surgery(5pare 40 college 12.5%),general surgery(9pare 40 department 22.5%),urology(13pare 40 department 32.5%),cardiology(2pm 40 grade 5%),endocrinology department(1pm 40 department 2.5%),most of the patients were treated in general surgery departments such as hepatobiliary,gastrointestinal and other general surgery departments,and most of the patients were treated in general surgery departments,such as hepatobiliary,gastrointestinal and other general surgery departments.The preoperative misdiagnosis rate was high.16 patients in this group were misdiagnosed before operation,and the misdiagnosis rate was as high as 40%.Among them,7 cases were misdiagnosed as adrenal tumors,accounting for the largest proportion.The first symptoms were varied,including 14 cases of abdominal pain(15%),7 cases of change of blood pressure(17.5%),6 cases of low back pain(17.5%),2 cases of hematuria(2 cases),2 cases of lower limb pain or numbness(2%),2 cases of abnormal blood glucose(2%),1 case of syncope(1 case),1 case of chest tightness after meal(140%),1 case of fever(140%),2 cases of abnormal blood sugar(2%),1 case of syncope(1 case),1 case of postprandial chest tightness(140%),1 case of fever(140%).Although the symptoms are various,there are not a small number of patients admitted to the hospital after physical examination,with a total of 7 cases(7 hands,40 minutes,17.5%).According to the mode of treatment and postoperative conditions,all patients were treated by operation,25 cases were treated by laparotomy(62.5%),15 cases were treated by laparoscopy (37.5%),of which 1 case was converted to laparotomy.Abdominal bleeding occurred in 2 patients undergoing laparotomy and 1 patient undergoing laparoscopic surgery,which was improved after conservative treatment.When the tumor is larger than 7cm,there is a greater possibility of combined organ resection.40 cases were followed up,2 cases lost follow-up,the follow-up time was 3-36 months,and the average follow-up time was 31.75 months.among them,5 patients died of tumor metastasis in 3-35 months,3 patients died of sudden cardio-cerebrovascular stroke,2 patients underwent second operation of tumor metastasis,and 1 patient died of postoperative complications.One patient died of tumor metastasis 10 months after operation: there was no significant difference in sex and age between the functional group and the non-functional group(P > 0.05).Taking 7cm as the boundary,the tumor size of the two groups was compared,and the tumor size of the non-functional group was more than that of 7cm(7cm 0.047).There were more hemodynamic changes during operation in the functional group(Purge 0.045).There was no significant difference in hemodynamic changes between the laparoscopic group and the laparoscopic group(P > 0.05).The 3-year survival rate of the laparoscopic group was higher than that of the open group(P > 0.05).The 3-year survival rate of the laparoscopic group was higher than that of the open group(P < 0.05).Retroperitoneal schwannoma: a total of 32 patients were included,including 12 male patients(37.5%)and 20 female patients(62.5%).The ratio of male to female patients was 31.5%.The age of the patients ranged from 19 to 70 years old,with an average age of 45.19 ±14.30 years old.The proportion of patients in each department was hepatobiliary surgery(15.6%),gastrointestinal surgery(46.9%),general surgery(6.25%),urology(12.5%),orthopaedics(12.5%)and obstetrics and gynecology(6.25%).Most of the patients were treated in general surgery departments such as hepatobiliary,gastrointestinal and other general surgery departments.Preoperative diagnosis was difficult.7 patients were misdiagnosed before operation,and only 10 patients were diagnosed as schwannoma before operation.The first symptoms were varied,including 12 cases of abdominal pain(37.5%),6 cases of low back pain with lower limb pain or numbness(18.75%),and 1 case of difficulty in defecation(3.13%).However,there were not a small number of patients admitted to hospital for physical examination or trauma,with a total of 13 cases(30.6%).According to the mode of treatment and postoperative conditions,all patients were treated by operation,including 22 cases of open treatment(22 ppm,68.75%)and 10 cases of laparoscopic surgery(10 cases,325%),of which 1 case was converted to laparotomy.Two patients were asked to undergo paraspinal tumor resection by spinal surgery during the operation.One patient had left leg dysfunction after operation,and there was no improvement after symptomatic treatment.32 cases were followed up,3 cases lost follow-up,the follow-up time was 3-36 months,the average follow-up time was 31.88 months.Among them,3 patients died of tumor metastasis in 3-6 months,and 2 patients died of tumor metastasis after operation.9 months and 15 months after operation,respectively.There was no gender difference between benign tumor group and malignant tumor group(P > 0.05).The age of malignant tumor group was older than that of benign tumor group(Purge 0.003).The 3-year survival rate of malignant tumors was significantly lower than that of benign tumors(P < 0.05).Comparison between open surgery group and laparoscopic surgery group: there was no significant difference in 3-year survival rate between the two groups.There was no significant difference in sex and age between the two kinds of tumors.in terms of preoperative imaging findings,the cystic degeneration / necrosis of paraganglioma was mainly located in the periphery,while schwannoma was closer to the center.The plain CT value of paraganglioma was higher than that of schwannoma(P < 0.05).There was no significant difference in 3-year survival rate between the two kinds of tumors.Conclusion First,CT can be used as an effective means to distinguish the two kinds of tumors before operation.the cystic degeneration / necrosis of paraganglioma is mainly located in the periphery,while schwannoma is closer to the center,and the CT value of paraganglioma is higher than that of schwannoma.Second,retroperitoneal paraganglioma with diameter > 7cm is more likely to occur combined with organ resection,which needs to be prepared before operation.Third,retroperitoneal neurilemmoma pays more attention to multidisciplinary diagnosis and treatment than retroperitoneal paraganglioma.In our study,there are cases in which orthopedic surgery needs to be changed.It is suggested that if the tumor is closely related to the nerve root or has the symptoms of nerve root compression,spinal surgery should be consulted and treated together.Fourth,laparoscopic surgery will not increase the possibility of hemodynamic changes during paraganglioma surgery,and the 3-year survival rate of laparoscopic surgery is higher than that of open surgery.Laparoscopic surgery is recommended as the first choice for the treatment of retroperitoneal paraganglioma if there is no contraindication of laparoscopic surgery. |
PDF Full Text Request