儿童腹膜后肿瘤累及血管的外科治疗

Surgical management of retroperitoneal tumors involved blood vessels in children

目的探讨儿童腹膜后肿瘤累及血管的外科手术处理。方法回顾总结手术治疗腹膜后肿瘤94例,其中肾母细胞瘤40例,肾透明细胞肉瘤、恶性肾上腺皮质癌各1例,Ⅲ～Ⅳ期神经母细胞瘤52例,并对这些患儿的临床资料和诊疗经过进行分析。结果肾母细胞瘤5例瘤栓累及下腔静脉,3例切开血管壁取出瘤栓,2例化疗瘤栓缩小后再手术。肾透明细胞肉瘤1例,穿刺活检明确病理诊断后化疗、手术、放疗、恶性。肾上腺皮质癌1例,放弃治疗。Ⅲ～Ⅳ期神经母细胞瘤52例,均化疗后延迟手术。无血管损伤大出血、重要脏器受损切除等并发症的发生。结论儿童腹膜后肿瘤累及血管时手术难度大,需化疗、手术和放疗综合治疗,才能提高手术的切除率和安全性。

Objective To present our experience of surgical management of solid tumors involved blood vessel in children. Methods Ninety-four cases of retroperitoneal solid tumors including 40 cases of Wilms＇ tumors, 1 case of renal clear cell sarcoma, 1 of adrenocortical carcinoma, and 52 cases of Ⅲ-Ⅳ stage neuroblastoma were treated in Shanghai Children＇s Medical Center. The clinical data of tumors involved blood vessels in these children were retrospectively analyzed. Results The tumor thrombus involved in IVC was found in five cases of Wilms＇ tumors. Tumor thrombus was extracted in three cases,while the other two were removed after chemotherapy. And the tumor thrombus in 1 patient with renal clear cell sarcoma was removed after biopsy and chemotherapy. One case with adrenocortical carcinoma was given up treatment. In all fifty-two cases of Ⅲ-Ⅳ stage neuroblastoma, surgery was delayed after 3～4 course of chemotherapy. No blooding or important organ damage was noted in these cases. Conclusions The present study suggests that preoperative chemotherapy can increase the tumor resection rate in patients with tumors involved in blood vessels.