儿童原发性胃肿瘤15例临床分析及文献复习  

Clinical analysis of primary gastric tumors in 15 children

作　　者：郑娜[1] 李凯[1] 肖现民[1] 董岿然[1] 陈莲[2] 马阳阳[2] 

机构地区：[1]复旦大学附属儿科医院外科,上海201102 [2]复旦大学附属儿科医院病理科,上海201102

出　　处：《中华小儿外科杂志》2015年第5期378-382,共5页Chinese Journal of Pediatric Surgery

基　　金：卫生部部属（管）医院2010-2012年度临床学科重点项目（卫规财函[20101439号-41）（81071903）

摘　　要：目的总结儿童原发性胃肿瘤的临床特点，探讨其诊断和治疗方法。方法结合相关文献复习，对我院1993年3月至2014年3月诊治的15例儿童原发性胃肿瘤患儿的临床资料进行回顾性分析，入选患儿均为病理确诊为胃原发肿瘤，并对患儿术后情况进行随访。结果15例患儿，男9例，女6例，平均（6．5±4．3）岁，发病部位以胃体、胃窦部多见，肿块最大径平均值为（6．3±2．6）cm，首发症状多为腹痛、黑便、不明原因发热、面色苍白。单独或联合采用B型超声、CT、上消化道钡餐及胃镜检查，均表现为中上腹或胃内的巨块型或息肉样占位性病变。手术切除15例：3例单纯肿瘤切除术，7例行肿瘤在内的胃壁切除术＋胃壁修补术，4例行胃大部分切除术＋消化道重建，1例行姑息性胃癌切除术。术后化疗4例（3例胃恶性肿瘤和1例胃间质瘤）。随访时间3～92个月，期间失访4例，死亡1例（胃腺癌术后复发），2例胃腺瘤术后复发，余随访至今无复发或恶变。结论儿童原发性胃肿瘤罕见但病理类型多样，且多为间叶来源。症状多不典型，早期诊断困难。儿童胃原发性肿瘤以良性及交界性多见，手术是主要的治疗方式，预后较好，但交界性和恶性肿瘤有复发和恶变倾向，应密切随访，恶性肿瘤的化疗原则及标准方案有待进一步临床研究。Objective To summarize the clinical characteristics, diagnosis and treatment of primary gastric tumors in children. Methods In combination with a related literature review, the clinical data of 15 children with pathologically confirmed primary gastric tumors from March 1993 to March 2014 were analyzed retrospectively. And their postoperative conditions were followed up. Results There were 9 boys and 6 girls with an average age at diagnosis of （6. 5 ± 4. 3） years. The most common sites were gastric body and gastric antrum. And the average maximum diameter of mass was （6. 3 ± 2. 6） era. The major onset symptoms were abdominal pain, melena, fever of undetermined origin and pallor. Alone or in combination with ultrasound, computed tomography （CT） and upper gastrointestinal barium meal and gastroscopy, huge mass in abdomen or stomach or polypoid spaceoccupying lesions were visualized. The procedures were simple tumor resection （n = 3）, gastric wall resection plus gastric repair （n = 7）, subtotal gastric resection with digestive tract reconstruction （n = 4） and palliative resection of gastric carcinoma （n = 1）. And malignant gastric tumors （n = 3） and gatric stromal tumor （n = 1） received postoperative chemotherapy. During a follow-up period of 3-92 months, 4 cases were lost and 1 case died of gastric adenocarcinoma. Two cases of gastric adenomas were recurrent and others survived without recurrence or progression. Conclusions Primary gastric tumors are rare in children. However, the pathological types are diverse. Most of them Originate from mesenchymal tissue. Early diagnosis is difficult due to atypical symptoms. Benign and borderline gastric tumors are more common than primary gastric tumor in children. Surgery is a major treatment with a good prognosis. But malignant and borderline tumors have a great tendency of recurrence and progression so that close follow-ups are necessary. For gastric malignant tumor, the principle and standard regimens of chemotherapy should be further

关 键 词：儿童 胃肿瘤 诊断 临床方案 

分 类 号：R735.2[医药卫生—肿瘤]