34例小儿神经母细胞瘤临床分析

Clinical Analysis of 34 Cases of Children with Neuroblastoma

目的探讨小儿神经母细胞瘤发病临床特点及治疗措施,改善预后。方法对郑州大学第一附属医院2005年1月至2011年1月收治的34例神经母细胞瘤患儿的临床资料进行分析。结果临床表现情况:发病年龄5个月～14岁,平均3.2岁;确诊前平均就诊时间5.6个月。首发部位于后腹膜占64.7%(22/34),发热为主要症状占44.1%(15/34),肿块为主要体征占100.0%(34/34)。诊断情况:病理确诊者32例,其中神经母细胞瘤23例,神经节母细胞瘤9例;影像结合胸水培养发现神经细胞确诊者2例。临床分期:Ⅱ期4例,Ⅲ期7例,Ⅳ期23例。实验室检查情况:26例行24 h尿香草扁桃酸定量检测,其中>30mg/24 h 8例,≤30 mg/24 h 18例;31例行血清乳酸脱氢酶检测,其中>700 u.L-112例,≤700 u.L-119例;8例行血清甲胎蛋白定性检测,均为阴性。生存情况:6例无瘤生存,10例带瘤生存,7例因术后放弃化疗而死亡,11例因病情恶化或复发死亡。1 a生存率82.5%,2 a生存率55.9%,5 a生存率11.7%。结论对影像学检查发现腹腔结节、肿物,而体检未发现其他阳性体征,并排除感染性疾病后的儿童,医生应高度警惕,考虑该病的可能性;对术后需化疗的病例,要增强信心,鼓励患儿及家长,克服困难,及时配合并坚持完成化疗。

Objective To analyze the clinical characteristics and therapeutic measures of the pediatric neuroblastoma for improving the prognosis. Methods The clinical data of 34 children with neuroblastoma, who were inpatients in the first affiliated hospital of Zhengzhou university from January 2005 to January 2011, were analyzed. Results The onset ages were from 5 months to 14 years old, and the mean age was 3.2 years ; primary tumor location in the retroperitoneum accounted for 64.7% （22/34） ,the fever as the main symptoms accounted for 44.1% （15/34） ,masses as the main signs accounted for 100.0% （34/34）. Thirty-two cases were diagnosed by pathological examination,23 cases of neuroblastoma,9 cases of ganglion tumor; and 2 cases were diagnosed by image combined with pleural effusion culture showing the nerve cells. Four cases in clinical stage Ⅱ ,7 cases in Ⅲ,23 cases in Ⅳ. Twenty-six cases were detected with vanillylmandelic acid （VMA） in 24 h urine,VMA of 8 cases 〉 30 mg/24 h,VMA of 18 cases ≤30 mg/24 h; 31 cases were detected with serum lactate dehydrogenase （LDH） ,LDH of 12 cases 〉 700 u · L^-1 ,LDH of 19 cases ≤700 u · L^-1 ; 8 cases detected with serum alpha fetal protein,were all negative. Six cases of disease-free survival, 10 cases with tumor survival ,7 cases died of giving up chemotherapy after surgery, 11 cases of death due to disease progression or recurrence. The 1-year survival rate was 82.5%, the 2- year survival rate was 55.9% ,5-year survival rate was 11.7% ,respectively. Conclusion Finding nodules or masses in abdominal cavity by imaging examination and no other positive signs, and eliminating infective disease, we should be on high alert, and suspect the child suffering the disease; for the children who need postoperative chemotherapy, we should enhance their confidence, and encourage them to overcome difficulties, and adhere to the completion of chemotherapy.