儿童双侧肾母细胞瘤手术后复发的再治疗  

Treatment of recurrent bilateral Wilms tumor in children: a report of 10 cases

作　　者：屈彦超[1] 张潍平[1] 孙宁[1] 田军[1] 李明磊[1] 宋宏程[1] Qu Yanchao;Zhang Weiping;Sun Ning;Tian Jun;Li Minglei;Song Hongcheng(Department of Urology,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院泌尿外科,北京100045

出　　处：《临床小儿外科杂志》2022年第12期1123-1127,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的总结双侧肾母细胞瘤手术治疗后复发的临床特点及治疗经验,以提高双侧肾母细胞瘤的总体治疗水平。方法回顾性分析首都医科大学附属北京儿童医院泌尿外科2008年1月至2020年12月收治的10例双侧肾母细胞瘤复发患儿临床资料,包括患儿初次手术情况、复发时间及部位、后续治疗方法及随访情况等。结果10例中男7例,女3例,发病年龄10~69个月,平均27.3个月。初次手术的20侧中,18侧采取保留肾单位的肿瘤剜除术;1侧因肿瘤位于肾门处,保留肾脏困难而行瘤肾根治性切除术;1侧因肾内占位为多发小瘤灶而未行手术。术后病理均为预后良好型,未见间变型。复发时间为术后2~36个月。1例为双侧复发,同时有腹膜后淋巴结转移,未再行手术,以化疗为主,后转移至纵隔,最终死亡。一侧复发的9例患儿中,1例予单纯化疗9个月,肿瘤消失;8例予再次手术,仍采用保留肾单位的肿瘤剜除术;5例无再次复发;3例二次复发患儿中,1例术后再次出现原位复发合并肺转移,再次行瘤肾切除术及肺叶楔形切除术,无瘤生存至今,其余2例因多处转移而最终死亡。术后均予化疗,化疗药物包括长春新碱、阿霉素、环磷酰胺、依托泊苷和卡铂,方案不完全一致。术后1例进行了放疗。10例患儿随访时间19~108个月,1例失访;3例死亡;1例带瘤存活;其余5例均无瘤生存,至随访时患儿血清肌酐和尿素氮均正常。结论双侧肾母细胞瘤复发后可再行肿瘤切除术(nephron-sparing surgery,NSS),同时辅以加强化疗,可有相对较好的预后。Objective To summarize the clinical characteristics and treatment experiences of recurrent bilateral Wilms tumor and improve its overall treatment level.Methods From January 2008 to December 2020,retrospective review was performed for clinical data of 10 children hospitalized with bilateral recurrent Wilms tumor.Initial operation,recurrent time/site,treatment options and follow-ups were recorded.Results There were 7 boys and 3 girls with an average age of 27.3(10-69)month.A total of 18 tumors underwent nephron-sparing surgery.One child underwent nephrectomy since tumor was located in hilum and preserving kidney proved difficult.Two cases were not operated due to multiple small tumors.Postoperative pathology revealed a favorable prognosis and there was no anaplasia Postoperative recurrence time was(2-36)months.In one case,bilateral recurrence occurred immediately with retroperitoneal lymph node metastasis.Surgery was not re-performed and chemotherapy predominated.Death occurred after mediastinal metastasis.All the other 9 cases were detected initially in unilateral kidney.In one case,tumor disappeared after 9-month chemotherapy alone.Nephron-sparing surgery(NSS)was performed in 8 children.Recurrence was absent(n=5)and secondary(n=3).One child had postoperative in situ recurrence with pulmonary metastasis.And tumor nephrectomy and wedge resection of pulmonary lobe were performed.Another two cases died from multiple metastases.Postoperative chemotherapeutic agents included vincristine,doxorubicin,cyclophosphamide,etoposide and carboplatin.However,regimen was not completely unified.Postoperative radiotherapy was offered for only 1 child.During a follow-up period of(19-108)months,1 case became lost,1 child survived with tumor,3 cases died and the remainders survived without tumor.Serum creatinine and urea nitrogen were both within a normal range during follow-ups.Conclusion NSS may be re-performed for recurrent bilateral Wilms tumor.In conjunctions with intensive chemotherapy,the prognosis is still relatively decent.

关 键 词：WILMS瘤 泌尿外科手术 复发 再手术 儿童 

分 类 号：R73[医药卫生—肿瘤]