手术完全切除肿瘤对晚期神经母细胞瘤患儿生存率的影响  

The impact of gross total resection on survival in children suffering from high-risk neuroblastoma with analysis of clinical effects for 21 cases

作　　者：刘洲禄[1] 肖元宏[1] 陈迪祥[1] 王政[1] 苏刚[1] 彭少林[1] 刘贵麟[1] 

机构地区：[1]解放军总医院小儿外科,北京市100853

出　　处：《临床小儿外科杂志》2009年第1期31-34,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的分析21例Ⅲ期、Ⅳ期腹膜后神经母细胞瘤患儿经血管骨骼化方法完全切除肿瘤后的临床疗效，探讨手术完全切除肿瘤对晚期神经母细胞瘤患儿生存率的影响。方法2003年至2008年，对本院收治的22例临床诊断为Ⅲ期、Ⅳ期神经母细胞瘤的患儿，经穿刺活检病理诊断明确为神经母细胞瘤后，按照最新国际标准化疗方案行4～6个疗程的化疗，待肿瘤体积缩小后，采用腹膜后大血管骨骼化的方法实施手术，21例完全切除肿瘤，并继续化疗等治疗。通过门诊复查及电话、信件随访的方式了解术后康复情况，包括有无原位复发、有无远隔转移、是否存活以及死亡原因等。结果21例延期一期手术完全切除肿瘤（占95．45％），无严重的术后并发症及围手术期死亡。失访3例。随访病例中，无瘤存活10例，占55．56％；带瘤存活3例，占16．67％；死亡5例，占27．78％，5年总体生存率为72．22％（13／18）。结论通过腹膜后大血管骨骼化方法完全切除儿童Ⅲ期、Ⅳ期神经母细胞瘤，能显著提高术后生存率。Objective To study the clinical results of 21 children suffered from the advanced retrnperitoneal neuroblastoma when treated with vascular skeletalization surgery. Methods From 2003 to 2008,22 neuroblastoma with stages of Ⅲ and Ⅳ were included in this study. Diagnosis was ascertained through puncturing biopsy. After 4 to 6 cycles of chemotherapy programs according to the international standard, with decreasing of the tumor sizes, surgery of vascular skeletalization was performed. Twenty-one children achieved gross total resection of the tumor followed by continuing chemotherapy, bone marrow transplantation. With the methods of clinic follow-ups, telephones or letters to the parents, we learned the recovery condition of the children postoperatively, including if recurring of the primary, sites, if metastasis to the remote sites, alive or dead, and the causes of death. Using the methods of skeletalization of the large retroperitoneal vessels, twenty-one children obtained the gross total resection of the tumor. The operative details and results were discussed. Results 21 cases （95.45%） obtained gross total resection of the tumors. There were no serious complications and perioperative death. Except for 3 cases failed to be followed up,among the 19 children, 10 children are in the state of tumor-free,3 are living with tumor-residual and 5 were dead. Excluding 3 cases failed of following up, the rate of 5-year-survival is 72.22% （13 / 18）. Conclusions Using the technique of vascular skeletalization retro-peritoneally to achieve delayed total gross resection for the advanced neuroblastoma of children, a significantly high survival rate has been obtained.

关 键 词：神经母细胞瘤 外科学 

分 类 号：R730.264[医药卫生—肿瘤] R735.2[医药卫生—临床医学]