腹膜后肾肿瘤切除术与经腹肾肿瘤切除术治疗小儿双侧肾母细胞瘤的疗效比较及预后分析  

Curative effect and prognosis comparison in treating children with bilateral Wilms tumor by retroperitoneal nephrectomy or transabdominal nephrectomy

作　　者：宋东建[1,2] 岳丽芳[3] 杨合英[1] 范应中[1] 刘秋亮[1] 张大[1] 夏自强[1] 贾佳[1] 张俊杰[1] 张辉[1] 王家祥[1] Song Dongjian Yue Lifang Yang Heying Fan Yingzhong Liu Qiuliang Zhang Da Xia Ziqiang Jia Jia Zhang Junjie Zhang Hui Wang Jiaxiang(Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Chin Institute of Clinical Medicine, the First Affiliated Hospital of Zhengzhou University ,Zhengzhou 450052, China Department of Ultrasonogra- phy, the Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Chin)

机构地区：[1]郑州大学第一附属医院小儿外科,450052 [2]河南省高等学校临床医学重点学科开放实验室,450052 [3]郑州大学第三附属医院超声科,450052

出　　处：《中华实用儿科临床杂志》2016年第20期1571-1574,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金（81172085）

摘　　要：目的探讨腹膜后肾肿瘤切除术与经腹肾肿瘤切除术在小儿双侧肾母细胞瘤中的临床应用及疗效。方法回顾性分析1997年4月至2014年7月入住郑州大学第一附属医院小儿外科的27例双侧肾母细胞瘤患儿的临床资料，其中9例行经腹膜后肿瘤切除术（研究组），18例行经腹肿瘤切除（对照组），比较不同术式患儿围手术期各项临床参数及生存资料。结果研究组患儿手术时间[（129．5±13．9）min]、术后ICU时间[（6．3±3．1）d]、住院时间[（13．9±3．9）d]及肠功能恢复时间[（6．8±3．4）d]均明显低于对照组[（149．5±26．7）min、（9．7±3．8）d、（20．5±3．0）d、（11．5±3．1）d]，2组比较差异均有统计学意义（t=2．129，P=0．051；t=2．551，P=0．017；t=4．489，P〈0．001；t=3．488，P=0．002）。研究组患儿术中出血量[（95．5±14．6）mL]、术后肾功能恢复时间[（22．3±3．1）d]及随访平均肌酐水平[（67．0±21．3）μmol／L]均低于对照组[（105．9±23．1）mL、（24．7±4．5）d、（76．8±13．3）μmol／L]，2组比较差异均无统计学意义（t=1．231、1．485、1．474，P=0．243、0．163、0．154）。研究组患儿术中不良事件发生率[0（0／9例）]、术后尿漏并发症发生率[11．1％（1／9例）]均低于对照组[11．1％（2／18例）、16．7％（3／18例）]，但2组比较差异无统计学意义（P=0．103、0．093）。研究组患儿中位生存时间高于对照组，且平均累计生存风险低于对照组（28．5个月，95％CI：23．2-33．7个月比22．4个月，95％CI：12．6—32．1个月；χ2=0．469，P=0．494）。结论经腹膜后肿瘤切除术可降低手术、术后ICU及住院时间，避免了肠操作，减少术后肠粘连并发症概率及经口进食等待时间，可作为一种治疗小儿双侧肾母细胞瘤可行的手术方式。Objective To explore the clinical application and efficacy in the treatment of children with bilate- ral Wilms tumor（BWT） by retroperitoneal nephrectomy or transabdominal nephrectomy. Methods Clinical data of 27 children with BWT in which 9 cases underwent retroperitoneal nephrectomy （study group） while 18 cases underwent transabdominal nephreetomy （control group） at Department of Pediatric Surgery, the First Affiliated Hospital of Zheng- zhou University from April 1997 to July 2014 were retrospectively analyzed. The perioperative clinical parameters and survival data were compared between the study group and the control group. Results The operation duration [ （129.5 ± 13.9） mini ,the length of intensive care unit （ICU） postoperatively [ （6.3 ± 3. 1 ） d], hospital stay [ （ 13.9 ±3.9 ） d] and the time to resuming an oral diet[ （6.8 ± 3.4） d] of the study group were markedly lower than those of the control group [ （ 149.5 ± 26. 7） rain, （9.7± 3.8 ） d, （20.5 ± 3.0） d, （ 11.5 ± 3.1 ） d ], and the diffe- rences were statistically significant （ t = 2. 129, P = 0.051 ; t = 2.551, P = 0.017 ; t = 4. 489, P 〈 0.001 ; t = 3. 488, P = 0. 002）. The estimated blood loss [ （95.5 ± 14. 6 ） mL], postoperative renal recovery time [ （22.3 ± 3. 1 ） d ] and mean serum creatinine levels by follow - up [ （67. 0 ± 21.3） μmol/L] of study group were lower than those of the con- trol group [ （ 105.9 ± 23.1 ） mL, （24.7 ±4. 5 ） d, （76.8 ± 13.3 ） μmol/L], but the differences were not significant （ t = 1.231,1. 485,1. 474,P = 0. 243,0. 163,0. 154 ）. There was a similar tendency that intraoperative adverse event rates [ 0 （0/9 cases） ] and postoperative urine leakage rates [ 11.1% （1/9 cases） ] of the study group were lower than those of the control group [ 11.1% （2/18 cases）, 16. 7% （ 3/18 cases） ], but the differences were not significant （ P = 0. 103,0. 093）. Study group revealed longer median survival time than that of the

关 键 词：腹膜后肾肿瘤切除术 经腹肾肿瘤切除术 双侧肾母细胞瘤 儿童 

分 类 号：R737.11[医药卫生—肿瘤]