不同评分系统在儿童肾上腺皮质肿瘤手术前后评估中的应用  

Application of various scoring systems to the preoperative and postoperative evaluation of adrenal cortex neoplasms in children

作　　者：朱小江[1] 黄立渠 沙锦铜 汪俊 顾楠楠 郭云飞[1] 邓永继[1] Zhu Xiaojiang;Huang Liqu;Sha Jintong;Wang Jun;Gu Nannan;Guo Yunfei;Deng Yongji(Department of Urology,Children's Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院泌尿外科,南京210008

出　　处：《中华小儿外科杂志》2025年第3期193-197,共5页Chinese Journal of Pediatric Surgery

基　　金：国家自然科学基金(82000643);江苏省自然科学基金青年项目(BK20200152)。

摘　　要：目的探讨不同评分系统在儿童肾上腺皮质肿瘤手术前后评估中的价值。方法回顾分析2017年6月至2022年9月南京医科大学附属儿童医院10例肾上腺皮质肿瘤患儿的临床资料。2例患儿为体检发现,其余8例患儿中,1例出现库欣貌,2例出现性早熟,5例出现男性化表现。10例患儿中,5例行开放肾上腺肿瘤切除术,5例行腹腔镜肾上腺肿瘤切除术。使用美国儿童肿瘤协作组(Children's Oncology Group,COG)分期、五项显微镜病理评分、Wieneke评分及pS-GRAS评分系统分别对患儿进行评估。结果根据COG分期,10例患儿中5例为Ⅰ期,3例为Ⅱ期,2例为Ⅲ期。术后病理结果显示:肾上腺皮质癌3例,肾上腺皮质腺瘤5例,恶性潜能未定的肾上腺皮质肿瘤2例。pS-GRAS评分分布为:1分1例,2分2例,3分5例,4分2例。术后随访3~61个月,1例死亡,1例失访,其余8例患儿正常随访中。结论目前Wieneke评分在儿童肾上腺皮质肿瘤中使用最广泛,但其仅涉及组织学评价,而综合性的pS-GRAS评分系统需进一步进行大范围前瞻性研究以明确其临床应用价值。Objective To investigate the value of various scoring systems in the pre-and post-surgical evaluation of adrenal cortex neoplasms in children.Methods The clinical data of 10 children with adrenal cortex neoplasms treated at Children's Hospital of Nanjing Medical University from June 2017 to September 2022 were retrospectively analyzed.Two cases were were identified through physical examination.Among the remaining 8 cases,1 case had Cushing's appearance,2 cases had precocious puberty,and 5 cases had virilization.Five patients underwent open adrenalectomy and the other 5 underwent laparoscopic adrenalectomy.These children were evaluated separately using the Children's Oncology Group(COG)staging,5-item microscopic score,Wieneke score and pediatric S-GRAS(pS-GRAS)score.Results According to COG staging,there were 5 stageⅠcases,3 stageⅡcases and 2 stageⅢcases.Postoperative pathological results showed 3 cases of adrenocortical carcinoma,5 cases of adrenocortical adenoma,and 2 cases of adrenocortical tumor with undetermined malignant potential.The pS-GRAS score showed 1 case with 1 point,2 cases with 2 points,5 cases with 3 points,and 2 cases with 4 points.The follow-up period ranged from 3 to 61 months.One case died,1 case was lost to follow-up,and the remaining 8 cases were doing well.Conclusions The Wieneke score is currently the most widely used in pediatric adrenal cortex neoplasms,but it involves only histological evaluation,while the comprehensive pS-GRAS scoring system requires further large-scale prospective studies to clarify the value of clinical application.

关 键 词：肾上腺肿瘤 围手术期 儿童 评估 

分 类 号：R736.6[医药卫生—肿瘤]