小儿神经母细胞瘤的临床分析

Clinical analysis of neuroblastoma in children

目的探讨小儿神经母细胞瘤的诊断和治疗。方法结合相关文献对我科经手术治疗的80例小儿神经母细胞瘤患儿的临床资料进行回顾性分析，男54例，女26例，来源于肾上腺36例，交感神经节44例（其中腹膜后20例，纵膈12例，颈部12例），47例无远处转移的患儿先手术切除瘤体（含1例IVs期患儿），后多药联合化疗，33例远处发生转移活检病理结果明确为神经母细胞瘤后给予术前化疗，待转移灶消失后给予手术治疗，术后多药联合化疗。结果80例手术患儿行根治性切除72例，姑息性切除8例，完全切除视野内瘤体的比率为90％。术中行血管修补4例，其中腹主动脉1例，下腔静脉3例。64例随访患儿生存38例，Ⅰ期、Ⅱ期、Ⅲ期共28例，Ⅳ期8例，ⅣS期2例。3例术后复发再次行手术治疗，术后继续给予化疗，现生存良好，2例带瘤生存。结论神经母细胞瘤恶性程度高，诊断时瘤体多已侵及主要血管，手术技巧对于神经母细胞瘤的治疗至关重要，完全切除视野内的瘤体对于提高神经母细胞瘤患儿的生存率有很大的作用。对于远处发生转移患儿先行穿刺，病理结果明确为神经母细胞瘤后给予术前化疗，待转移灶消失后给予手术治疗。神经母细胞瘤如能做到早期诊断、及时手术加规律化疗等综合治疗，预后相对较好。

Objective To explore the clinical characteristics of neuroblastoma in children. Methods The clinical data of 80 children with neuroblastoma were analyzed. And the relevant litera- tures were reviewed. There were 54 males and 26 females. The sources were from adrenal gland （n = 36） and sympathetic ganglion （n = 44）. Forty-seven cases which the other parts were not invaded were first operated and then chemotherapeutics were taken,the other were opposite. Results All of them underwent surgery. Among them, neuroblastoma was completely removed in 72 patients and partially removed in 8. Vascular repair was performed in 4 patients. During follow-ups, among 64 cases, 16 patients became lost, 38 survived cases and another 3 required reoperation due to postoperative re lapse. Conclusions The malignancy of neuroblastoma is high and its surgical techniques are crucial for optimal management. Complete resection may increase the survival rate. And a better prognosis is a- chieved if it can be early diagnosed and treated timely.