腔镜在小儿肿瘤治疗中的应用

Endo-surgery for the Treatment of Tumor in Children

目的探讨腔镜手术治疗小儿肿瘤的可行性、安全性、有效性。方法 2001年1月～2009年3月,应用腔镜手术治疗小儿肿瘤45例,男27例,女18例。年龄28天～12岁(<1岁12例,≥5岁6例),肿瘤直径2～15cm。对良性肿瘤及囊性肿瘤大小不作限制;对恶性实体肿瘤,选择直径<5cm者应用腔镜进行切除。良性肿瘤35例:甲状腺肿瘤4例,腹部畸胎瘤2例,卵巢囊肿13例,肠系膜淋巴管瘤1例,肠系膜囊肿1例,腹膜后巨大囊肿1例,肾上腺腺瘤6例,胰腺囊肿1例,胰腺胰岛素瘤1例,肾囊肿2例,纵隔肿瘤3例,肿瘤直径3～15cm,(7.3±2.8)cm;恶性肿瘤10例:肾上腺神经母细胞瘤2例,肾母细胞瘤2例,腹部恶性畸胎瘤2例,纵隔恶性畸胎瘤1例,肺转移肿瘤3例,肿瘤直径2～5cm,(4.2±0.9)cm。均通过腔镜行肿瘤切除术,术中冰冻病理确诊,对良性肿瘤实施肿瘤完整切除,对恶性肿瘤采用根治性切除。结果 45例全部手术成功,无中转开放手术,无不能完整切除者。手术时间30～185min,(112.6±41.7)min。出血量5～50ml,无输血病例。手术后第1～3天进食水,住院时间平均3～10d(6.5±2.5)d。术后无并发症发生。无围手术期死亡。术后病理回报肿瘤切除完全,边缘无肿瘤组织残留。术后随访6个月～8.5年,35例良性肿瘤均健康生存,无肿瘤复发;10例恶性肿瘤中8例仍健康生存,2例肝母细胞瘤肺转移患儿术后5、10个月因多发转移死亡。结论应用腔镜手术治疗小儿良性、囊性肿瘤及直径<5cm的恶性实体肿瘤可行、安全、有效。

Objective To evaluate the feasibility,efficacy and safety of endo-surgery for children with tumor.MethodsTotally 45 children with tumor（27 male and 18 female）underwent endo-surgery in our hospital from January 2001 to March 2009.The patients aged from 28 days to 12 years（12 cases aged 1 year,and 6 cases ≥5 years）.Of the patients,benign tumors were detected in 35 cases,and malignancies in 10 patients.Among the benign cases,thyroid tumor was found in 4 cases,abdominal teratoma in 2 cases,ovarian cyst in 13,mesenteric lymphangioma in 1,mesenteric cyst in 1,post-peritoneal giant cyst in 1,adrenal adenoma in 6,pancreatic cyst in 1,pancreatic insulinoma in 1,renal cyst in 2,and mediastinal tumor in 3;the diameter of the tumors ranged from 3-15 cm with a mean of（7.3±2.8）cm.In the malignant cases,2 cases of adrenal neuroblastoma,2 cases of Wilms＇ tumor,2 cases of abdominal malignant teratoma,1 case of mediastinal malignant teratoma,and 3 cases of pulmonary metastatic tumor were diagnosed;the diameter of the malignancies ranged from 2 to 5 cm with a mean of（4.2±0.9）cm.Endo-surgery was performed in all of the 45 patients,and total or radical resections were made after frozen section examination.Results The endo-surgery was completed in all of the 45 cases without conversion to open surgery.The operation time ranged from 30 to 185 min with a mean of（112.6±41.7）min;during the operation,no patients received blood transfusion,the blood loss ranged from 5 to 50 ml.Oral liquid and food intake were resumed in 1 to 3 days after the surgery.The mean hospital stay of this series of patients was（6.5±2.5）days（ranged from 3 to 10 days）.No patient had complications or peri-operative death.Post-operative pathological examination showed completed removal of the tumor without residual tumor tissues in all of the cases.Follow-up was achieved in all the patients for 6 months to 8.5 years,during which the 35 benign cases were healthy without recurrence,and 8 of the 10 malignant cases survived uneventfully;the other 2 malignant cases who had pulmonary metastatic hepatoblastoma died of multiple metastasis in 5 and 10 months respectively after the operation.Conclusions Endo-surgery is feasible,safe,and effective for children with benign or cystic tumor,or malignant tumor less than 5 cm in diameter.Skillful techniques and reliable imaging examination are helpful to make sure the success of the operation.