CAJ | 학술논문

目的探讨儿童胃肠道原发性肿瘤的临床特点及诊治经验.方法对2009年1月至2014年4月在我院接受手术治疗的17例原发性胃肠道肿瘤患儿临床资料进行回顾性分析,女6例,男11例,初诊及手术年龄为3个月～14岁,平均5.5岁.临床表现主要包括腹部包块、腹痛、呕吐、发热、体重下降、消化道出血等.CT、超声及消化道内镜检查发现胃肠道占位性病变14例,腹部X线片提示肠梗阻3例.肿瘤原发于胃部:蓝色大疱痣2例,恶性畸胎瘤1例;发生于肠道:肠管及系膜淋巴管瘤3例,Burkitt淋巴瘤3例,粘液性印戒细胞癌2例,原始神经外胚层性肿瘤3例,血管瘤2例,弥漫性大B细胞瘤1例.分析患儿的临床表现、影像学资料、肿瘤类型、肿瘤发生部位、治疗方式以及预后情况.结果 14例患儿行肿瘤侵犯(胃)肠管切除吻合术(3例淋巴管瘤患儿同时行注射用A群链球菌注射),3例行肿瘤活检术.10例恶性肿瘤中1例术后第6天死亡,1例患儿术后第2天自动出院放弃治疗和1例患儿术后拒绝化疗出院,出院后均失访,余7例术后均接受化学治疗.出院后对患儿进行门诊或电话随访,7例良性肿瘤和7例恶性肿瘤术后辅助化疗患儿获随访6个月～5年不等,均存活至今,无肿瘤复发及转移.结论儿童胃肠道肿瘤发病隐匿,早期诊断困难,常并发外科急腹症,CT、彩超及消化道内镜检查有助于诊断,手术需尽可能完整切除肿瘤,恶性肿瘤术后需化疗.患儿预后与肿瘤性质密切相关,原发性良性肿瘤预后良好,化疗可提高恶性肿瘤患儿的生存率,同时要对肿瘤患儿进行长期随访,了解肿瘤有无复发及转移.
목적 탐토인동위장도원발성종류적림상특점급진치경험.방법 대2009년1월지2014년4월재아원접수수술치료적17례원발성위장도종류환인림상자료진행회고성분석,녀6례,남11례,초진급수술년령위3개월～14세,평균5.5세.림상표현주요포괄복부포괴、복통、구토、발열、체중하강、소화도출혈등.CT、초성급소화도내경검사발현위장도점위성병변14례,복부X선편제시장경조3례.종류원발우위부:람색대포지2례,악성기태류1례;발생우장도:장관급계막림파관류3례,Burkitt림파류3례,점액성인계세포암2례,원시신경외배층성종류3례,혈관류2례,미만성대B세포류1례.분석환인적림상표현、영상학자료、종류류형、종류발생부위、치료방식이급예후정황.결과 14례환인행종류침범(위)장관절제문합술(3례림파관류환인동시행주사용A군련구균주사),3례행종류활검술.10례악성종류중1례술후제6천사망,1례환인술후제2천자동출원방기치료화1례환인술후거절화료출원,출원후균실방,여7례술후균접수화학치료.출원후대환인진행문진혹전화수방,7례량성종류화7례악성종류술후보조화료환인획수방6개월～5년불등,균존활지금,무종류복발급전이.결론 인동위장도종류발병은닉,조기진단곤난,상병발외과급복증,CT、채초급소화도내경검사유조우진단,수술수진가능완정절제종류,악성종류술후수화료.환인예후여종류성질밀절상관,원발성량성종류예후량호,화료가제고악성종류환인적생존솔,동시요대종류환인진행장기수방,료해종류유무복발급전이.
Objective To explore the clinical features and the diagnosis and surgical treatment of primary gastrointestinal tumors in children.Methods The clinical data including tumor sites,pathological types,clinical manifestation,imaging findings,effective treatment and prognosis were retrospectively analyzed for 17 consecutive surgical patients at our department between January 2009 and April 2014.There were 11 males and 6 females with a mean age of 5.5 (0.25-14) years.The major clinical manifestations were abdominal mass,abdominal pain,vomiting,fever,emaciation and alimentary tract hemorrhage.In 14 patients,computed tomography (CT),ultrasound and gastrointestinal endoscopy showed space-occupying lesions in gastrointestinal tract.And abdominal radiology demonstrated intestinal obstruction in another 3 cases.Primary gastric tumor was found in 3 cases,including blue rubber bleb nevus syndrome (n =2) and malignant teratoma (n =1).And intestinal tumor was found in 14 cases,including intestinal lymphangioma (n =3),malignant lymphoma (n=4),signet ring cell carcinoma (n =2),original neural ectoderm tumor (n =3) and hemangioma (n=2).Results Among them,14 cases underwent (gastric) intestinal resection and anastomosis and the remainder received an injection of Streptococcus A Group.And biopsy was performed in 3 cases.For 10 cases with malignant tumor,1 case died at Day 6 post-operation,1 case was discharged with discontinued treatment at Day 2 post-operation and another case declined postoperative chemotherapy.Except for 3 cases lost to follow-ups,the other 7 ones underwent postoperative chemotherapy.Both 7 cases with benign tumors and another 7 with malignant tumors on adjuvant postoperative chemotherapy were followed up for 6 months to 5 years.All survived without tumor recurrence or metastasis.Conclusions Due to unspecific presentations,the diagnosis is difficult for children with primary tumor.It is often complicated with acute abdominal.Computed tomography,ultrasound and gastrointestinal endoscopy may aid the diagnosis.The tumor should be removed completely as far as possibl.Primary benign tumor has a fair prognosis.Surgical resection or combinational chemotherapy are indicated for treating malignant tumors.At the same time,further long-term follow-ups should be conducted for elucidating the mechanisms of tumor recurrence and metastasis.