摘要目的 探讨儿童神经母细胞瘤的诊断、治疗及预后.方法 对河南省人民医院小儿外科2013年8月至2018年8月收治的36例神经母细胞瘤患儿的临床资料进行回顾性分析.其中男22例,女14例;年龄1个月~13岁[(20. 0 ± 18. 5)个月].来源于交感神经节15例(其中腹膜后7例,后纵隔6例,颈部2例),来源于肾上腺髓质21例.低危组、中危组患儿(共15例)先手术切除瘤体,后多药联合化疗;高危组患儿(共21例)先行彩超引导下粗针穿刺活检术,病理结果明确后给予术前诱导化疗,经评估瘤体可基本完全切除时进行手术,术后多药联合化疗.结果 36例手术患儿行根治性切除23例(63. 9%),姑息性切除13例,术中行血管修补2例(腹主动脉1例、下腔静脉1例).随访到有效信息27例,生存16例,Ⅰ期、Ⅱ期、Ⅲ期共12例,Ⅳ期2例,Ⅳs期2例,4例术后复发再次行手术治疗,术后继续给予化疗,现生存良好,3例带瘤生存.结论 儿童神经母细胞瘤恶性程度高,易发生远处转移,根治性切除瘤体可提高神经母细胞瘤患儿的生存率.神经母细胞瘤如能做到早期诊断、及时手术、术后规律化疗则预后较好.

abstractsObjective To explore the diagnosis,treatment and prognosis of neuroblastoma in children. Methods The clinical data of 36 children With neuroblastoma admitted to Department of Pediatric Surgery,Henan Pro﹣vincial People＇s Hospital betWeen August 2013 and August 2018,Were retrospectively analyzed. The patients included 22 males and 14 females With the age of 1 month－13 years old[( 20. 0 ± 18. 5)months]. TWenty－one cases of neu﹣roblastoma originated from the adrenal glands,the other 15 cases from the sympathetic ganglion( including 7 cases in retroperitoneum,6 cases in postmediastinum,and 2 cases in neck). Fifteen patients in loW risk and intermediate risk groups underWent primary surgery before multiple chemotherapy,While other 21 cases in high risk groups underWent chemotherapy until the mass could be removed completely,then continuely underWent multiple chemotherapy. Results Of the 36 patients,23 cases(63. 9%)had a radical resection,13 patients underWent palliative resection and 2 pa﹣tients Were treated With vascular repair during surgery(abdominal aorta in 1 patient,inferior vena cava in 1 patient). TWenty－seven patients had effective in formation and 16 patients survived,during folloW－up,12 patients belonged to stage Ⅰ－Ⅲ disease,2 patients stage Ⅳ disease and 2 patients stage Ⅳs disease,respectively. Four cases underWent re－operation due to disease recurrence,then they underWent chemothearopy,and 3 patients Were survival With tumor. Conclusions Neuroblastoma is a highly malignant pediatric cancer accompanied With a high rate of metastasis on ini﹣tial diagnosis. Radical resection is an effective therapeutic strategy for improving the survival rate. If radical resection is impractical,palliative resection combined With chemotherapy can significantly prolong patients＇ survival time. And a better prognosis is achieved if it can be early diagnosed and treated timely.