儿童肺部恶性肿瘤七例临床分析  

Clinical analysis of seven cases of pulmonary malignant tumors in children

作　　者：徐丹[1] 陈志敏[1] 顾伟忠[2] 王颖硕[1] 黄美霞[1] 唐兰芳[1] 张园园[1] 姜源[1] 

机构地区：[1] 浙江大学医学院附属儿童医院呼吸科,杭州310052 [2] 浙江大学医学院附属儿童医院病理科,杭州310052

出　　处：《中华儿科杂志》2017年第4期298-303,共6页Chinese Journal of Pediatrics

摘　　要：目的 探讨儿童肺部恶性肿瘤的临床特点、影像学特点以及预后.方法 对2010年1月至2016年12月在浙江大学医学院附属儿童医院确诊的7例儿童肺部恶性肿瘤的临床、影像以及病理表现,治疗及预后等进行回顾性分析.结果 （1）本组均首诊于儿内科,症状例数：咳嗽6例、呼吸困难4例,发热、纳差各2例、胸闷、胸痛、跛行、腹胀及便秘各1例,未发现咯血、喘息或进行性消瘦的病例.体检：肺部听诊示5例单侧呼吸音减低,1例可闻及湿哕音及哮鸣音,1例肺部听诊无明显异常;肺外表现包括左髋关节压痛、左阴囊内包块各1例;未发现杵状指、贫血貌、淋巴结肿大、肝脾肿大等.（2）血常规示白细胞仅1例偏高,为17.44x109/L,其余均在正常范围,中性粒细胞0.348～0.767,C反应蛋白＜1～ 162 mg/L,均无贫血,血肿瘤标志物4例中有3例增高.（3）影像学：肺内多发结节状阴影3例,肺内多发囊腔性病变2例（均为胸膜肺母细胞瘤）,支气管内软组织块影1例,肺内类圆形肿块影1例,合并纵隔内肿块影1例.合并肺不张3例,气胸2例,纵隔疝2例,胸腔积液2例,皮下气肿1例.（4）所有患儿均接受肿瘤穿刺活检或肿瘤切除,经病理诊断确诊为：胸膜肺母细胞瘤3例,内胚窦瘤2例,鳞状细胞癌、甲状腺乳头状癌各1例.（5）随访：存活3例,死亡2例,失访2例.死亡患儿为胸膜肺母细胞瘤合并多处骨转移与胸膜肺母细胞瘤各1例,均放弃治疗出院.目前存活并在继续随访中的3例随访时间分别为19个月、1 1个月、2个月,1例甲状腺乳头状癌肺转移患儿接受右甲状腺癌根治＋甲状腺左叶切除＋改良选择性中央区淋巴结清扫术后,接受碘131治疗;1例内胚窦瘤肺转移患儿接受3次化疗后接受左腹膜后肿瘤切除＋左侧睾丸肿瘤切除术,再接受6次化疗;另1例内胚窦瘤肺转移予3次化疗后出院等待下次化疗.结论 儿童肺部恶性肿瘤并非少�Objective To understand the clinical manifestation,imaging characteristics and outcomes of pulmonary malignant tumors in children.Method We retrospectively collected information about seven cases of pulmonary malignant tumors in children in our hospital from Jan 2010 to Dec 2016.The information included clinical manifestation,imaging characteristics,pathologic results,and treatment.Result （1） All the seven patients firstly visited pediatric internal medicine departments.Symptoms included cough （n =6）,dyspnea （n =4）,fever （n =2）,anorexia （n =2）,chest tightness （n =1）,chest pain （n =1）,lameness （n =1）,abdominal distension and constipation （n =1）.We did not find hemoptysis,wheezing or weight loss in those patients.Physical examinations revealed unilateral reduced breath sounds （n =5）,moist rales and wheezes （n =1）,and normal （n =1）.Extrapulmonary signs included abdominal distension （n =2）,left hip tenderness （n =1）,and mass in left scrotum.We did not identify clubbing finger,anemic appearance,lymph node enlargement,or hepatosplenomegaly etc.（2） Laboratory examination results：complete blood count showed white blood cells in normal range except one case （17.44 ＆#215; 109/L）.Neutrophil percentage ranged from 0.348 to 0.767.C reactive protein ranged between 〈1 and 162 mg/L.Hemoglobin was normal.Three out of four cases had abnormal blood tumor markers.（3） Imaging results showed multiple nodes （n =3）,multiple cystic lesions in lungs （n =2） （both with pleuropulmonary blastoma）,endobronchial soft tissue mass （n =1）,pulmonary round-shaped mass （n =1）,and mediastinal mass （n =1）.Imaging results also found atelectasis （n =3）,pneumonia （n =2）,pneumothorax （n =2）,longitudinal diaphragmatic hernia （n =2）,pleural effusion （n =1）,subcutaneous emphysema （n =1）.（4） All the patients underwent tumor puncture biopsy or tumor resection.Pathology revealed the final diagnosis of pleuropulmonary blastoma （n =3）,e

关 键 词：恶性肿瘤 胸膜肺母细胞瘤 肺鳞状细胞癌 甲状腺乳头状癌 内胚窦瘤 

分 类 号：R734.2[医药卫生—肿瘤]