上海交通大学学报（医学版）

›› 2011, Vol. 31 ›› Issue (6): 817-.doi: 10.3969/j.issn.1674-8115.2011.06.030

• 论著（临床研究） • 上一篇    下一篇

儿童肾母细胞瘤个体化综合治疗的疗效分析

杨静薇, 蒋 慧, 陆正华, 邵静波, 李 红   

  1. 上海市儿童医院 上海交通大学附属儿童医院血液肿瘤科, 上海 200040
  • 出版日期:2011-06-28 发布日期:2011-06-27
  • 通讯作者: 蒋 慧, 电子信箱: jhui2006@yahoo.com.cn。
  • 作者简介:杨静薇（1971—）, 女, 主治医师, 硕士生；电子信箱: ywwww@yeah.net。

Therapeutic effects of individualized comprehensive treatment for Wilms tumor in children

YANG Jing-wei, JIANG Hui, LU Zheng-hua, SHAO Jing-bo, LI Hong   

  1. Department of Hematological Oncology, Shanghai Children's Hospital, Children's Hospital affiliated to Shanghai Jiaotong University, Shanghai 200040, China
  • Online:2011-06-28 Published:2011-06-27

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摘要：

目的 回顾性分析采用个体化方案对儿童肾母细胞瘤患者进行综合治疗的效果。方法 收集2005年9月—2009年12月经临床、影像学和病理学检查确诊为肾母细胞瘤患者的临床资料。38例患者中男性24例，女性14例；平均年龄2.67岁；单侧病灶37例，双侧病灶1例。根据患者个体情况制定综合治疗方案。单侧肿瘤首选经腹行肿瘤和患肾切除术；对于手术风险较大的单侧肿瘤患者则先行CT定位下细针穿刺活检后实施术前化疗，使肿块缩小、转移灶消失后再行手术；根据肿瘤的组织学类型及临床分期选择制定术后化疗或化疗联合放疗方案。随访时间为12~60个月。结果 总缓解率97.37%（37/38），总体生存率为89.47%（34/38），无瘤生存率86.84%（33/38）；临床分期Ⅰ期和Ⅱ期患儿的无瘤生存率分别为100%（17/17）和91.67%（11/12），显著高于Ⅲ期和Ⅳ期患者的60.00%（3/5）和66.67%(2/3)（P<0.01）；良好与不良组织学类型患者的总体生存率分别为96.77%（30/31）和57.14%（4/7），两者比较差异有统计学意义(P=0.001)。5例复发（占13.16%），其中3例为横纹肌肉瘤型。结论 个体化综合治疗对儿童肾母细胞瘤的治疗效果良好。不良组织学类型（如横纹肌肉瘤型）及晚期患者（临床分期Ⅲ期和Ⅳ期）的预后较差，应予以高度重视。

关键词: 肾母细胞瘤, 综合治疗, 儿童

Abstract:

Objective To investigate the therapeutic effects of individualized comprehensive treatment for Wilms tumor in children. Methods The clinical data of patients with Wilms tumor confirmed by clinical features, radiology and pathology from September 2005 to December 2009 were collected. Thirty-eight patients were included, with 24 males and 14 females, and the mean age was 2.67 years. There were unilateral lesions in 37 cases and bilateral lesions in 1 case. Individualized comprehensive treatment regimen was designed. Tumorectomy and nephrectomy were optimal approaches for unilateral lesions. For those with high risks for operation, chemotherapy was performed after fine needle aspiration biopsy to constrict the masses and eliminate the metastatic lesions, and operations were followed. Chemotherapy and chemotherapy combined with radiotherapy were designed after operation according to the histological types and clinical stages of tumors. Patients were followed up for 12 to 60 months. Results The total remission rate was 97.37% (37/38), the overall survival was 89.47% (34/38), and the disease-free survival was 86.84% （33/38）. The disease-free survival of patients with clinical stage Ⅰ and stage Ⅱ were 100% （17/17）and 91.67% （11/12）respectively, which were significantly higher than those of patients with clinical stage Ⅲ (60.00%, 3/5) and stage Ⅳ (66.67%, 2/3)（P<0.01）. The overall survival was 96.77％ (30/31) in patients with favorable histological types, that was 57.14％ (4/7) in patients with unfavorable histological types, and there were significant differences between them (P=0.001). Five patients experienced recurrence (13.16%), 3 of whom were rhabdomyosarcoma type. Conclusion Individualized comprehensive treatment may yield good therapeutic effects for Wilms tumor in children. Patients of unfavorable histological types (rhabdomyosarcoma type for example) and advanced stages (clinical stage III and stage IV) may have worse prognosis, and should be attached greater importance.

Key words: Wilms tumor, comprehensive treatment, children