摘要
目的探讨儿童肾上腺偶发瘤的临床特征及治疗方案的选择,并归纳其诊治流程。方法回顾性分析2016年12月至2021年10月南京医科大学附属儿童医院泌尿外科收治的38例儿童肾上腺偶发瘤的临床资料。将38例患儿按首诊时的年龄分为新生儿组及非新生儿组。新生儿组16例。其中男7例,女9例;产前检查发现7例,出生后发现9例;左侧4例,右侧12例;肿瘤长径16~48 mm。非新生儿组22例中,男14例,女8例;年龄7个月1 d至12岁1个月;肿瘤长径29~131 mm。良恶性肿瘤年龄比较及长径比较采用配对t检验。结果新生儿组中,手术3例,术后病理示神经母细胞瘤2例,畸胎瘤1例;观察随访13例,随访时间1~31个月,其中8例肿瘤完全消失,5例较前明显缩小。非新生儿组中行开放活检手术3例,腹腔镜下肾上腺肿瘤切除术9例,开放肾上腺肿瘤切除术10例。良性肿瘤共8例,其中节细胞神经瘤4例,肾上腺皮质腺瘤、肾上腺囊肿、畸胎瘤、嗜铬细胞瘤各1例;恶性肿瘤共14例,其中神经母细胞瘤8例,节细胞神经母细胞瘤5例,肾上腺皮质癌1例。恶性肿瘤患儿年龄(38.94±35.44)个月,良性肿瘤患儿年龄(95.89±41.43)个月,差异有统计学意义(t=3.63,P=0.001)。恶性肿瘤长径为(64.43±25.20)mm,良性肿瘤长径为(41.44±15.66)mm,差异有统计学意义(t=2.45,P=0.023)。结论儿童肾上腺偶发瘤恶性风险高,应进行详细的肿瘤标志物及内分泌功能等检测,同时应尽快完善CT等影像学检查。儿童肾上腺偶发瘤以神经母细胞性肿瘤多见,对非新生儿期患儿应尽快手术,对新生儿期及产前检查发现的肾上腺偶发瘤,如肿瘤较小,局限于肾上腺且无远处转移可行观察等待治疗。
Objective To explore the clinical characteristics and treatment regimens of adrenal incidentaloma(AI)in children.Methods Clinical data of 38 children with AI treated in the Department of Urology,Children′s Hospital of Nanjing Medical University from December 2016 to October 2021 were retrospectively analyzed.A total of 38 children were divided into neonatal group and non-neonatal group according to their age at first diagnosis.The neonatal group had 7 males and 9 females patients,of whom 7 cases were detected with AI during prenatal examinations,9 cases were diagnosed postnatally.Four children in neonatal group had AI in the left adrenal gland and 12 cases in the right,with the maximum diameter of tumor(MDT)ranging from 16-48 mm.In the non-neonatal group,there were 14 males and 8 females patients aged 7 months and 1 day to 12 years and 1 month,and the MDT was 29-131 mm.Paired t test was used to compare the age and MDT of benign and malignant tumors.Results In the neonatal group,3 patients were surgically treated,with 2 cases and 1 case of neuroblastoma and teratoma confirmed by postoperative histology,respectively.The remaining 13 patients in the neonatal group were followed up for 1-31 months,with 8 cases and 5 cases of complete remission and significantly decreased tumor volume,respectively.In the non-neonatal group,there were 3,9 and 10 patients received open biopsy,laparoscopic adrenalectomy,and open adrenalectomy,respectively.Of these 22 surgically treated cases,8 cases had a benign lesion,including ganglioneuroma(n=4),adrenocortical adenoma(n=1),adrenal cyst(n=1),teratoma(n=1),and pheochromocytoma(n=1);while 14 cases had a malignant lesion,including neuroblastoma(n=8),ganglioneuroblastoma(n=5),and adrenocortical carcinoma(n=1).The mean age of patients with malignant tumors was significantly younger than those with benign tumors[(38.94±35.44)months vs.(95.89±41.43)months,t=3.63,P=0.001].The mean MDT in malignant tumors was significantly longer than that of benign tumors[(64.43±25.20)mm vs.(41.44±15.66)
作者
朱小江
汪俊
顾楠楠
董隽
郭云飞
邓永继
Zhu Xiaojiang;Wang Jun;Gu Nannan;Dong Jun;Guo Yunfei;Deng Yongji(Department of Urology,Children′s Hospital of Nanjing Medical University,Nanjing 210008,China)
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2023年第5期356-359,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
南京市医学科技发展项目(YKK20122)
南京医科大学科技发展基金(NMUB20210064)。
关键词
肾上腺偶发瘤
儿童
恶性
临床分析
Adrenal incidentaloma
Child
Malignance
Clinical analysis
