recurrent retroperitoneal tumor
Introduction
Introduction to recurrent retroperitoneal tumors The retroperitoneal tumor is difficult to diagnose early because of its location. It is often found in the middle and late stages. One third of the cases are misdiagnosed and received incorrect treatment. Therefore, both malignant and benign tumors are prone to recurrence after surgical resection of the tumor. Timely detection of recurrent small lesions can be time and initiative for reoperation. basic knowledge The proportion of illness: 0.0021% Susceptible people: no special people Mode of infection: non-infectious Complications: anemia, hypokalemia, peritonitis
Cause
Causes of recurrent retroperitoneal tumors
(1) Causes of the disease
Primary retroperitoneal tumors are more likely to recur after surgery, the main reasons are:
1. The characteristics and tumor nature of the primary tumor: The primary characteristics and nature of the primary tumor are the primary causes of postoperative recurrence. According to statistics, the most common cases of primary retroperitoneal tumor recurrence are liposarcoma, followed by leiomyosarcoma. Malignant fibrous tissue sarcoma, neurofibrosarcoma, malignant mesothelioma, etc., the postoperative tumor recurrence time varies from 1 to 10 years after surgery, and those with high malignancy often relapse within 2 years after surgery.
2. The first surgical resection is not complete: the cause of recurrence In addition to the characteristics of the primary tumor and the nature of the tumor, the thoroughness of the first surgical resection of the tumor is the main factor determining the recurrence of the postoperative period. The retroperitoneal space is the peritoneal wall layer and the abdomen. The potential lacunar space between the transverse fascia, both sides of the transverse abdominis muscle, the ventral side wall composed of the iliopsoas muscle, the posterior lumbar muscle and the transverse abdominis tendon, the front of the abdominal cavity important organs and substantial organs and pelvis Organs, abdominal aorta, inferior vena cava and iliac vessels pass through; the main organs of the genitourinary system are the kidneys, ureters, spermatic cords, ovarian blood vessels in between; nerves and lymphatic networks are interlaced, and tumors in this area are difficult to detect early. When the diagnosis is clear, the tumor tends to be large, and the vital organs are wrapped or invaded. In the first operation, in order to avoid damage to certain important organs, it is difficult to completely remove the tumor tissue, and the residual tumor tissue is an important cause of postoperative recurrence. one.
3. Molecular genetic characteristics of tumors: Recent studies have shown that most soft tissue tumors have non-randomized clonal chromosomal abnormalities and/or gene mutations and amplifications, such as most fat tumors, regardless of their benign or malignant Different chromosomal abnormalities, due to the obvious molecular genetic characteristics of some tumors, its recurrence and multiple is an inevitable phenomenon.
4. Insensitive to chemotherapy and radiotherapy: Most of the primary retroperitoneal tumors are not sensitive to chemotherapy except lymphosarcoma and genital retroperitoneal tumors.
(two) pathogenesis
Clinical observations suggest that the recurrence of retroperitoneal tumors is mostly at the base of the primary tumor, and its growth pattern is similar to that of the primary tumor. Malignant recurrent retroperitoneal tumors are more likely to invade multiple organs or large blood vessels, and the tumor remains swollen after recurrence. Growth is dominant, the maximum diameter of the tumor is often above 10cm, there is still a pseudo-envelope formation, and there is little distant metastasis; the pathological type is the same as the primary tumor; however, the malignant degree of the tumor gradually increases after each recurrence, and the growth rate is significantly accelerated. The recurrence interval is getting shorter and shorter, and should be closely followed after primary tumor resection.
Prevention
Recurrent retroperitoneal tumor prevention
It is very important to review the time after surgery. It is possible to detect recurrent small lesions in time and gain time and initiative for reoperation. This is essential for improving the survival and prognosis of patients. For the early detection of recurrent cases, for the first tumor For complete resection, the time for each visit should not exceed 3 months. The time for resection of the tumor boundary is not certain or the residual time should be shortened. When the recurring tumor volume is small, the chance of complete resection is significantly increased.
Complication
Recurrent retroperitoneal tumor complications Complications anemia hypokalemia peritonitis
1. Anemia: Tumor hemorrhage or a retroperitoneal tumor in children grows faster, which can cause a decrease in hemoglobin.
2. Hypokalemia: When the tumor is large, when the gastrointestinal tract is pushed or pressed, the patient may suffer from loss of appetite, nausea and vomiting, diarrhea, etc., causing a large loss of potassium and insufficient supplementation, resulting in a decrease in blood potassium and a disorder of serum electrolytes.
3. Acute peritonitis: When the tumor ruptures, the blood may stimulate the peritoneum to have symptoms and signs of abdominal pain, abdominal muscle tension, tenderness, rebound tenderness and other acute peritonitis.
4. Low-volume shock: When the tumor ruptures or invades the large blood vessels, it can cause a lot of bleeding, and low-volume shock occurs.
Symptom
Recurrent retroperitoneal tumor symptoms Common symptoms Severe pain Abdominal mass abdominal pain
1. Abdominal mass: The abdominal mass reappeared after the first operation. The location of the tumor was the same as or similar to that of the primary retroperitoneal tumor. The knees were placed in the elbow and the hands were palpated. The tumor did not sag forward and there was a gong on the anterior wall of the abdomen, but the tumor was large. The anterior wall of the abdomen is also voiced, and the peritoneal tumor is often diagnosed as a normal bowel sound. A few patients have ascites, which are often difficult to sputum, and the auscultation of peristalsis is normal or slightly hyperactive.
2. Abdominal distension: As the tumor grows, the patient gradually develops a feeling of bloating. Because the gastrointestinal tract is displaced, it is often heard in the upper or side of the tumor. The peristalsis is normal or slightly hyperactive.
3. Abdominal pain: With the development of the disease, the abdomen has a feeling of bulging, heavy feeling, dull pain or pain. When the malignant tumor erodes adjacent organs or nerves, it can cause severe pain. The tumor may have back pain after invading the abdomen wall. Pain or numbness in one or both lower extremities.
4. Adjacent organ involvement: such as nausea and vomiting, diarrhea, constipation; internal hemorrhoids, umbilical varicose veins; jaundice; frequent urination, urgency, difficulty urinating; lower extremity edema, varicocele and so on.
Post-peritoneal tumors should be followed up after surgery to improve the understanding of retroperitoneal tumors.
Examine
Examination of recurrent retroperitoneal tumors
Laboratory inspection:
1. Blood routine:
(1) Hemoglobin: necrosis of the center of the malignant tumor, hemorrhage, or a rapid increase in the retroperitoneal tumor of the child may be accompanied by a decrease in hemoglobin.
(2) White blood cell count: There may be an increase in the total amount of white blood cells in the retroperitoneal tumor necrosis or secondary infection.
2. Histopathological examination: Diagnosis should be made by other methods before surgery. If necessary, laparotomy or laparoscopic surgery should be performed for biopsy.
Film degree exam:
1. B-ultrasound: as the first choice for routine follow-up examination, the first 3 months after surgery should start, through B-ultrasound can understand the location, size, number of recurrent tumors, and the relationship with the surrounding organs, you can judge the tumor For cystic or substantial, it can be identified from the retroperitoneal or peritoneal cavity to understand whether other organs are involved.
2. CT scan: B-ultrasound found recurrent tumor or suspicious person, feasible CT scan, CT can clearly show the tumor location, size, shape, and the relationship with the surrounding organs, blood vessels, provide the main basis for preoperative diagnosis and reoperation The positioning accuracy rate is 80%-90%, spiral CT can be multi-angle, multi-layer scan, second-stage reconstruction image, the shape of the aorta and its branches, the portal vein, the shape and number of recurrent tumors, and the adjacent organs Relationships, lymph node metastases and other tissues show clear, and the resolution is better than ordinary CT.
3. MRI: It can display soft tissue better, and it is feasible to check in multiple directions to understand the relationship between tumor and blood vessel. However, because of the high cost of examination, it can be used as a diagnosis for special difficult cases.
4. Digital subtraction angiography: can understand the main blood supply artery of the invasion of the main blood vessels and the tumor, and help to deal with the main blood vessels of the tumor during operation. While performing digital subtraction angiography, if the tumor is found to have major nourishment The blood vessels can be treated with interventional therapy and vascular embolization at the same time, so that the tumor is necrotic and reduced, and it is convenient for reoperation.
5. Intravenous pyelography and gastrointestinal angiography: can understand the ureter, gastrointestinal invasion and renal function, in preparation for combined organ resection.
Diagnosis
Diagnosis and diagnosis of recurrent retroperitoneal tumor
1. History: Primary retroperitoneal tumors more than 3 months after the first surgery, retroperitoneal sarcoma often relapse within 2 years after the first surgery.
2. Clinical features: Abdominal mass, located in the primary retroperitoneal tumor site, may have gastrointestinal or other organ involvement, early detection may also have no clinical symptoms and signs.
3. Auxiliary examination: B-ultrasound follow-up examination can initially understand the location, size, number and relationship with the surrounding organs, in order to clearly diagnose the feasible CT scan.
