摘要目的:探讨Trapdoor手术治疗儿童颈胸交界处神经母细胞瘤的临床应用价值。方法:收集浙江大学医学院附属儿童医院2018年1月至2021年10月经Trapdoor手术方式治疗的23例颈胸交界处神经母细胞瘤患儿的临床资料。其中男7例，女16例；肿瘤位于左侧19例，右侧4例；中位年龄为4岁4个月，年龄范围为6个月18 d~8岁7个月；手术时肿瘤最大径为（5.31±2.57）cm。根据国际神经母细胞瘤分期系统（ISSN分期）：Ⅲ期10例，Ⅳ期13例。按照美国儿童肿瘤协作组（children's qncology group，COG）进行危险度分组：中危9例，高危14例。所有患儿均经前正中"C"型切口（锁骨上、胸骨正中及肋间切口），暴露锁骨后方及胸腔进行肿瘤切除，骨骼化颈胸大血管。记录手术相关指标及术后并发症，并随访所有患儿的复发、生存情况。结果:所有病例均顺利完成手术且达到肉眼全切。手术时间为（3.81±1.64）h，术中出血（57.65±28.61）ml。26.1%（6/23）的患儿发生并发症。3例出现声音嘶哑，2例出现肺不张伴肺炎，2例出现肋骨骨折，1例出现乳糜漏，通过治疗均得到恢复，未出现因手术并发症而死亡的病例。术后复查增强CT影像均未见肿瘤残留。临床随访3个月至3年，共有17.4%（4/23）患儿出现病情进展或复发（2例为手术部位，另2例为转移灶），均为Ⅳ期高危组。3例患儿在随访期间死亡，其中2例死因为疾病进展，另1例为化疗骨髓抑制后严重感染。结论:Trapdoor手术方式在术中视野暴露、手术完全切除方面具有优势，且并发症可控，是一种安全有效的手术方式，可作为治疗儿童颈胸交界处神经母细胞瘤的一种选择方法。

abstractsObjective:To evaluate the clinical application value of Trapdoor incision for neuroblastomas at cervicothoracic junction in children.Methods:From January 2018 to October 2021, clinical data were collected for 23 hospitalized children with neuroblastoma at cervical and thoracic junction. There were 7 boys and 16 girls. The involved side was left (n=19) and right (n=4). The median age was 4Y4M (6M18D-8Y7M). The maximal diameter of tumor was (5.31±2.57) cm. According to the International neuroblastoma staging System (ISSN), the clinical stages were Ⅲ (n=10) and Ⅳ (n=13). According to the criteria of Children's Oncology Group (COG), the clinical risks were moderate (n=9) and high (n=14). The operative duration was (3.81±1.64) h and intraoperative bleeding (57.65±28.61) ml. Postoperative complications occurred (n=6, 26.1%), including hoarseness (n=3), rib fracture (n=2), atelectasis (n=2) and chylous leakage (n=1). Gross total resection was performed through anterior C-notch (supraclavicular, median sternum & intercostal incision), exposing posterior clavicle and thoracic cavity and skeletonizing large cervical and thoracic vessels. Operation-related parameters and postoperative complications were recorded, and recurrence and survival followed up.Results:Recovery was smooth without any mortality from surgical complications. Tumor residue was absent on postoperative enhanced computed tomography (CT). During a follow-up period of 3 months to 3 years, there was disease progression or recurrence (n=4). All of them were in high-risk group of stage Ⅳ. Among 3 deaths, the causes were disease progression (n=2) and infection, severe pneumonia and respiratory failure caused by bone marrow suppression after chemotherapy (n=1). The remainders survived.Conclusion:Trapdoor surgical approach is ideal for neuroblastomas at cervicothoracic junction in children. It provides an excellent exposure for gross total resection with fewer perioperative complications.