肾母细胞瘤综合治疗后长期生存者的随访研究

The follow-up study of Wilms,tumour long-term survivors after combined therapy

目的探讨肾母细胞瘤综合治疗后,长期生存者的生存状况,以期探索更加合理,有效的治疗方案,提高长期生存率和生存质量。方法对1981年7月～1999年12月,共117例肾母细胞瘤患儿进行回顾性分析和随访;用寿命表法分别计算各临床分期的5年生存率;FH、UH生存率的差别用卡方检验,各临床分期生存率的差别用2×C表分析。结果共收集长期生存者67例,随访率70.9%。重点分析生存者的身体生长发育,残余肾脏功能及代偿的情况,免疫系统,生殖系统,造血系统,复发与第二肿瘤。结论放疗后的脊柱侧弯和腰肌发育不良使患儿的身高低于正常,术后及放射性肾炎会影响残余肾脏功能,放射性脊神经根炎为可逆性,综合治疗后免疫系统出现T淋巴细胞亚群的异常和比例失调,是否对子代造成影响仍需继续观察,对造血系统的影响不大。定期随访,以期早发现、早治疗肾母细胞瘤复发和2次肿瘤。

Objective To investigate the conditions of long-term survivors of Wilms’ tumour after combined therapy. To explore a more reasonable and effective therapeutic regimen and improve the rate of long-term survival and quality of life. Methods 117 patients diagnosed with Wilms’ tumour between July 1981 and December 1999 were reviewed and followed-up. The five-year survival rate of every clinical stage was calculated using a life table. The difference between the survival rate of FH and UH was analyzed by chi-square. The difference at each clinical stage was analyzed by 2 × C table. Restilts 67 long-term survivors were studied among 117 cases. The follow-up rate was 70. 9%. We analysed the condition of somatic growth, the hematopoietic system, reproductive system, immunologic system, compensation of remnant renal, relapse and second tumour. Conclusions After the therapy, the height of patients is shorter than normal, leading to scoliolosis and psoas dysplasia. Retro-operation and radiation nephritis influence the remnant renal function. Radiation spine nerve root phlegmasia is reversible. The proportion of the T-lymph cell subgroup is abnormal. The filial effect still needs review. Hematopoietic system is not often carried out after combined therapy. We should strive to detect relapses of WT and second turnours early for better management.