后腹膜孤立性纤维瘤复发再手术一例

doi:10.12280/gjszjk.20250339

摘要/Abstract

摘要：

报告1例后腹膜孤立性纤维瘤（solitary fibrous tumor，SFT）患者的首次治疗、术后10年随访及复发后的诊疗情况。2015年首次手术腹腔镜下完整切除位于后腹膜左侧骶骨前肿瘤，病理提示SFT，局灶细胞丰富；术后无症状，患者未规律随访。2022年首次发现复发，体检及系列影像检查发现盆腔直肠旁结节，后逐渐增大并数量增多，2023年复查结节继续增大，于2024年11月再次手术，腹腔镜左侧深部后腹膜肿瘤切除+髂内动脉旁肿瘤切除+盆腔粘连松解术，病理提示SFT，细胞密度增高，核分裂象稍增多[<4个/10高倍镜视野（high-power field，HPF）]。术后6个月，患者因持续尿潴留康复治疗，暂未行复查。后腹膜SFT非常罕见，属于低度恶性肿瘤，存在复发风险，建议终身随访。该患者肿瘤位于后腹膜盆底深部，邻近盆底神经、血管，推荐术前多学科诊疗（multi-disciplinary team，MDT），术中多学科联合手术可显著提高手术安全性和成功率。

关键词: 孤立性纤维瘤, 多学科诊疗, 复发, 诊断, 治疗

Abstract:

A case of retroperitoneal solitary fibrous tumor (SFT) in our hospital was reported. The first treatment, 10-year follow-up and diagnosis and treatment after recurrence were summarized. In 2015, the first surgery was performed to completely remove the tumor located in the left anterior sacrum of retroperitoneum under laparoscopy. Pathology showed SFT with the rich focal cells. There were no symptoms after the first surgery, and the patient was not followed up regularly. Recurrence was first detected in 2022: physical examination and a series of imaging examinations revealed pelvic pararectal nodules, which gradually increased in the number and volume. In 2023, the reexamination revealed that nodules continued to increase. In November 2024, the operation of laparoscopic left deep retroperitoneal tumor resection plus tumor resection near internal iliac artery plus pelvic adhesiolysis was performed. Pathology showed SFT, and the increased cell density and slightly increased mitotic figures (<4 per 10 high-power fields). After six months of the second surgery, the patient did not undergo reexamination due to the continuous urinary retention rehabilitation therapy. Retroperitoneal SFT is very rare, which is belonged to low-grade malignant tumor. SET has recurrence risk, suggesting the necessity of lifelong follow-up. The tumor of this patient is located in the deep part of retroperitoneal pelvic floor, adjacent to pelvic floor nerves and blood vessels. Multi-disciplinary team (MDT) should be recommended for the preoperative diagnosis and treatment. Intraoperative multidisciplinary surgery can significantly improve the safety and success rate of surgery.

Key words: Solitary fibrous tumors, Multi-disciplinary team, Recurrence, Diagnosis, Therapy

张玉华, 周欢, 郇荔荔, 田青青, 黄磊. 后腹膜孤立性纤维瘤复发再手术一例[J]. 国际生殖健康/计划生育杂志, 2025, 44(6): 475-480.

ZHANG Yu-hua, ZHOU Huan, HUAN Li-li, TIAN Qing-qing, HUANG Lei. Reoperation for Recurrent Retroperitoneal Solitary Fibrous Tumor: A Case Report[J]. Journal of International Reproductive Health/Family Planning, 2025, 44(6): 475-480.

图/表 4

图1 2015年术前下腹部/盆腔横断面MRI T2加权成像图注：1 膀胱，2 子宫，3 直肠；箭头所示为直肠左侧腹膜后间隙内可见实质性占位灶

图2 2015年术后病理图注：A 箭头所示肿瘤细胞呈短梭形至椭圆形，间质富含胶原，可见血管壁玻璃样变，HE染色×200，标尺=100 μm；B STAT-6部分细胞的细胞核阳性，免疫组织化学染色×200，标尺=100 μm

图3 2024年术前下腹部/盆腔横断面MRI T2加权图注：盆腔左侧后腹膜区域见数枚大小不等实质性结节，箭头A所示为直肠旁间隙实质性结节，箭头B所示为左侧卵巢旁前方实质性结节，箭头C所示为左侧卵巢旁后方实质性结节

图4 2024年手术后病理图注：A 短梭形或卵圆形细胞杂乱排列，HE染色×200，标尺=100 μm；B STAT-6部分细胞核阳性，免疫组织化学染色×200，标尺=100 μm

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