摘要
目的总结小儿神经母细胞瘤（NB）的诊断与治疗经验。方法根据病理、骨髓、影像学、尿3-甲氨基-4羟基杏仁酸（VMA）测定，分析17例NB临床资料。结果男10例，女7例。平均年龄5．3岁。就诊前平均病程2．8月。后腹膜为首发部位占11／17（64．7％）。主要症状为发热9／17（53％）。，主要体征为肿块占17／17（100％）。诊断：病理确诊者16例；影像加胸水培养发现神经细胞1例。病理分类：病理确诊的16例中，神经母细胞瘤者12例，神经节母细胞瘤者4例。临床分期：Ⅳ期13例；Ⅲ期2例；Ⅱ期2例。其它化验：乳酸脱氢酶（LDH）共做7例均增高。ESR共做3例均增高。，Hb共做17例，降低4例，平均102．6g/L，范围64～122g／L。治疗：Ⅲ、Ⅳ期者在化疗前或化疗中择期手术，Ⅱ期者手术后化疗。15例未坚持完成治疗，未治自动出院1例，正在治疗1例。结论①对骨关节肌肉疼痛、发热、体检未发现任何阳性体征，但影像学发现腹腔结节或肿物，排除感染性疾病以后，医生应提高警惕，早作腹腔探查术。②对术前已确诊的病例，需由多学科（小儿肿瘤内科、病理科、手术科、放疗科、放射科）密切配合，联合讨论最佳的治疗方案。③外科医生术中要提供分期的重要依据，以便化疗。术后加强与小儿肿瘤内科联系，以提高长期无病生存率。
Objective To summarize experiences of diagnosis and treatment of children with neuroblastoma （NB）. Methods To analyze the clinical materials of 17 cases with NB. The diagffOStlC memods were based on the features of histopathology, bone marrow, radiology and urine VMA. Results Male 10 eases, female 7 eases. Average age is 5.3 years. Average length of disease before hospitalized is 2.8 months. The main location of the tumor is retroperitoneum 11/17（64.7% ）. The main symptoms are fever 9/17（53% ）. The main sign is mass 17/17（ 100% ）. and nerve cell revealed during culture of hydrothorax 1 Diagnosis： histopathology 16 cases, radio imaging case. Histopa. thologieal classification： NB 12 cases and ganglioblastoma 4 cases. Chmcal staging ： Ⅳ 13 cases, Ⅲ 2 cases, Ⅱ 2 case. Other tests ： LDH tested in 7 cases all of them were increased. ESR in 3 cases all of them were increased. Hb decreased in 4 cases （average 102.6 g/L）. Therapy： stage Ⅲ and Ⅳ cases were operated before or during chemotherapy, stage Ⅱ case was chemotherapy after operation. Fifteen cases were not completed treatment course. One case gave up treatment. One case is been curomg. Conclusion （1） Patient with skeleton articulation muscular pain, fever and without any physical sign but abdominal imaging examination reveal nodule or masse doctor should be aware and to do exploratory laparotomy earlier after exclude infective disease. （2） The cases of diagnosis before operation should be take a conference to select the best therapeutic protocol and cooperate closely by multiple disciplines including departments of pediatric oneology, pathology, surgery, radiotherapy and radiology. （3） Surgeon should provide importance of. staging basis durl operation, in order to the chemotherapy. After operation surgeon should keep in positive contact with pediatrician of oneology to continuous chemotherapy therefore long-term event free survival rate of NB will increase possibly.
出处
《中国小儿血液与肿瘤杂志》
CAS
2006年第6期305-307,336,F0003,F0004,共6页
Journal of China Pediatric Blood and Cancer
关键词
小儿
神经母细胞瘤
诊断
治疗
Children
Neuroblastoma
Diagnosis
Therapy
