小儿巨大胸腔肿瘤伴呼吸窘迫的诊治策略探讨  

Diagnosis and treatment strategy for the patients with respiratory distress compressed by giant thoracic tumor in children

作　　者：仇万山 张文波[1] 沈啸 张惠锋 陶麒麟 陈刚 贾兵 Qiu Wanshan;Zhang Wenbo;Shen Xiao;Zhang Huifeng;Tao Qilin;Chen Gang;Jia Bing(Cardiovascular Center,Children's Hospital of Fudan University,Shanghai 200032,China;Pediatric Surgery,Children's Hospital of Fudan University at Qidong/Qidong Women's and Children's Health,Qidong 226200,China)

机构地区：[1]复旦大学附属儿科医院心血管中心,上海200032 [2]复旦大学附属儿科医院启东分院/启东市妇幼保健院小儿外科,226200

出　　处：《中华转移性肿瘤杂志》2021年第4期251-254,共4页Chinese Journal of Metastatic Cancer

基　　金：国家儿童医学中心,复旦大学附属儿科医院儿科临床研究中心专病队列研究项目(2020ZBDL17)

摘　　要：目的探讨小儿巨大胸腔肿瘤伴对重要脏器压迫所致危重症的诊治策略。方法回顾性分析2011—2021年间我科收治的小儿巨大胸腔肿瘤伴有呼吸窘迫患儿128例临床资料,包括性别、年龄、好发部位、临床表现、影像学表现及病理诊断、治疗。结果128例患儿中男75例、女53例,年龄9月至15岁,平均(8.24±1.08)岁,学龄期及幼儿期最常见。肿瘤巨大压迫心脏21例,压迫支气管及肺脏57例,压迫上腔及主动脉9例,同时压迫心脏、气管及肺脏41例。除常规肿瘤系列检查外,93例均行B超或CT定位下穿刺活检,明确初步诊断。4例入院36h内未及完成检查即死亡,49例完善检查和术前准备后直接手术,15例快速检查和评估后急诊手术,17例大剂量激素冲击治疗后亚急诊手术。43例转科化疗后再手术切除,随后继续巩固化疗。术后门诊复诊和电话随访6个月至5年,良性肿瘤术后恢复较好,100%生存;恶性肿瘤中35例恶性肿瘤转入血液科化疗和62例转肿瘤科化疗,出院后6个月内死亡2例;2年死亡7例,5年内死亡28例,13例化疗后失访,其余目前病情平稳,5年生存率65%。结论小儿胸腔肿瘤类型多样,发展迅速,易压迫重要脏器伴有呼吸窘迫;应尽快完善相关检查,特别是穿刺活检与其他影像检查同期进行;Ⅰ期手术完整切除机会少,联合治疗是其首选治疗方案。Objective To explove the diagnosis and treatment strategy of children's huge thoracic tumor with critical diseases caused by compression of important organs.Methods From July 2011 to July 2021,128 child patient with giant thoracic tumor accompanied by respiratory distress were treated in our department.Their clinical data were analyzed retrospectively that includes gender,age,prone site,clinical manifestations,imaging manifestations,pathological diagnosis and treatment methods.Results Of the 128 children,75 males and 53 females,aged 9 month to 15 years,average(8.24±1.08)years.The patients in school age and early childhood were most common.There were 21 cases of giant tumor with compression on heart,57 cases compression on bronchus and lung,9 cases on superior vena cava and aorta,and 41 cases compression on heart,trachea and lung simultaneously.In addition to routine tumor examination,93 patients underwent puncture biopsy under ultrasound or CT localization to confirm the preliminary diagnosis.4 cases died within 36 hours after admission without completing the examination,49 cases underwent elective surgery after completing examination and preoperative preparation,15 cases underwentemergency operation after rapid examination and evaluation,and 17 cases underwent subemergency operation after high-dose hormone therapy.43 cases were transferred to receive chemotherapy and then underwent operation,followed by consolidation chemotherapy.The patients were outpatient and followed up by telephone for 6 months to 5 years.The patients diagnosed with benign tumor recovered well with 100%survived.Among patients with malignant tumors,35 cases were transferred to hematology department for chemotherapy and 62 cases were transferred to oncology department for chemotherapy,and 2 cases died within 6 months after discharge.7 patients died within 2 years,28 patients died within 5 years,13 patients were lost to follow-up after chemotherapy,and the rest were in stable condition.The 5-year survival rate was 65%.Conclusions Thoracic tum

关 键 词：小儿 胸腔肿瘤 压迫 呼吸窘迫 诊治策略 

分 类 号：R734[医药卫生—肿瘤] R725.6[医药卫生—临床医学]