延期手术对小儿恶性肿瘤患者器官保存和长期生存的作用

Effect of delayed operation on organ preservation and long term survival inxchildren with malignant tumors

目的总结延期手术治疗小儿恶性肿瘤的临床疗效，探讨其对器官保存和长期生存的积极作用。方法应用延期手术治疗５２例（神经母细胞瘤２９例、肾母细胞瘤１１例、横纹肌肉瘤１２例）晚期恶性肿瘤，总结手术切除率、器官肢体保存率、长期生存率、组织病理和ＤＮＡ及细胞时相变化，并与７９例一期手术病例对照分析。结果延期手术的肿瘤切除率（９２．１％）明显高于一期手术组（６５．８％），而累及脏器切除率（３．８％）较一期手术组（１７．７％）明显减少。延期手术的２年生存率８３．２％，５年生存率５０％，与一期手术组（５６．９％和３７．２％）有显著差异。组织病理提示术前化疗使肿瘤细胞坏死、固缩，增殖活性下降。结论延期手术是小儿晚期恶性肿瘤治疗的有效手段，具有提高肿瘤切除率、保存器官肢体和争取长期生存的积极作用。

Objective To summerize the clinical efficacy of preoperative chemotherapy and delayed operation and to assess its role in organ presevation and long term survival in children. with malignant tumors. Methods 52 cases of late stage malignant tumors (neuroblastoma 29, Wilms' tumor 11, rhabdomyosarcoma 12) received delayed operation. The rate of resectability, organ preservation, long term survival, pathololgic changes, DNA and cell cycle were compared with 79 control cases with primary operation. Results The delayed operation group had remarkably higher tumor resectability rate (92.1%) than the primary operation group (65.8%), and had lower rate of organ removal (3.8% vs 17.5%). In delayed operation group, 2 years and 5 years survival rate were 83.2% and 50%, respectively, whereas in the primary operation group, they were only 56.9% and 37.2% respectively. Pathologyic changes showed preoperative chemotherapy resulted in tumor cell necrosis, pyknosis and decrease of proliferating activilty. Conclusion Delayed operatire with preoperation chemotherapy can increase the rate of resectability, preserve the organ and extremity, and prolong the survival period of childern with late stage maglignant tumors.