CAJ | 학술논문

目的：肾母细胞瘤是儿童预后较好的实体肿瘤之一，肺、肝、骨骼等是其发生血行远处转移的常见器官，也是影响疾病疗效的重要因素。文中旨在探讨儿童肾母细胞瘤合并远处转移时的临床特点和预后。方法收集南京医科大学附属南京儿童医院从2011年09月至2015年05月收治的9例儿童肾母细胞瘤患儿临床资料，所有患儿均行超声或CT检查和手术后肿块病理、免疫组化等确诊，通过手术、放疗和化疗联合治疗后，进行电话或门诊随访，随访时间至2015年06月，分析其临床特点、病理特点和转归情况。结果患儿初诊时临床症状均表现为腹部包块、腹胀或腹痛。7例为肺部转移，1例肝转移，1例为肺部和肝同时转移。9例患儿病理类型中7例为预后良好型，2例为预后不良型。通过手术、放疗和化疗联合治疗，至随访结束时9例患儿中1例因肿瘤原发部位复发死亡；1例仍在化疗中，肿瘤原发部位未复发；7例患儿处于缓解状态，其中4例通过CT检查肺部转移灶完全消失，2例肺部转移灶较前明显缩小或钙化，1例肝转移灶已消失。腹部CT平扫＋增强证实7例缓解患儿原发肿瘤病灶均未复发。结论肺、肝为儿童肾母细胞瘤肿瘤转移的常见部位，通过放疗、化疗和再次手术能取得一定的缓解。
목적：신모세포류시인동예후교호적실체종류지일，폐、간、골격등시기발생혈행원처전이적상견기관，야시영향질병료효적중요인소。문중지재탐토인동신모세포류합병원처전이시적림상특점화예후。방법수집남경의과대학부속남경인동의원종2011년09월지2015년05월수치적9례인동신모세포류환인림상자료，소유환인균행초성혹CT검사화수술후종괴병리、면역조화등학진，통과수술、방료화화료연합치료후，진행전화혹문진수방，수방시간지2015년06월，분석기림상특점、병리특점화전귀정황。결과환인초진시림상증상균표현위복부포괴、복창혹복통。7례위폐부전이，1례간전이，1례위폐부화간동시전이。9례환인병리류형중7례위예후량호형，2례위예후불량형。통과수술、방료화화료연합치료，지수방결속시9례환인중1례인종류원발부위복발사망；1례잉재화료중，종류원발부위미복발；7례환인처우완해상태，기중4례통과CT검사폐부전이조완전소실，2례폐부전이조교전명현축소혹개화，1례간전이조이소실。복부CT평소＋증강증실7례완해환인원발종류병조균미복발。결론폐、간위인동신모세포류종류전이적상견부위，통과방료、화료화재차수술능취득일정적완해。
[Abstract ] Objective Nephroblastoma is one of the solid malignancies with fair prognosis in children .The lungs, liver, and bones are the common organs for distant metastasis of the tumor and important factors influencing the therapeutic effects as well .This study was to investigate the clinical characteristics and prognosis of nephroblastoma with distant metastasis in children . Methods We retrospectively analyzed the clinical characteristics , pathological features , and prognosis of 9 cases of nephroblastoma with distant metastasis treated in Nanjing Children Hospital from September 2011 to May 2015 . Results The patients presented with abdominal masses, distention and pain at preliminary diagnosis and confirmed with nephroblastoma , with pulmonary metastasis in 7 cases, liver metastasis in 1, and lung and liver metastases in the other .All were treated by surgery, radiotherapy, and chemotherapy and followed up for a median time of 34 months.By the end of the follow-up, 1 patient died of recurrence , 1 was undergoing chemotherapy , and the other 7 were being recovered, including complete disappearance of lung metastasis in 4, obvious reduction or calcification of lung metastasis in 2, evident disappearance of liver metastasis in 1, but relapse in none. Conclusion Lung and liver are common sites of nephroblastoma metastasis in children .As for the treatment of the disease , relatively good results can be achieved by radiotherapy , chemotherapy , and reoperation .