儿童肾母细胞瘤的保肾治疗.docVIP

儿童肾母细胞瘤的保肾治疗 　　作者：苏诚， 叶根榕， 李穗生， 潘翠玲， 刘唐彬， 詹文华 作者单位：( 1.中山大学附属第一医院小儿外科， 广东 广州　 510080; 2. 东莞市人民医院外科， 广东 东莞　 521308 ) 　　【摘要】 【目的】 探索儿童肾母细胞瘤(WT)保肾治疗方案和提高WT患儿长期生存率、改善生存质量的诊疗方案。【方法】 根据诊治方案不同，将我院261例WT患儿分为A、B两组，通过比较A、B两组的疗效，分析外科、病理、影像、化疗、放疗等学科在提高WT疗效，改善长期生存质量中的作用以及多学科协作综合治疗对保肾治疗的作用。【结果】 A组WT诊治以影像学诊断+手术治疗为主，B组WT诊治强调明确的病理分型与临床分期以及个体化的多学科综合治疗方案。A、B两组WT患儿在2年/5年生存率、保肾治疗率、手术并发症及长期生存质量等方面均存在显著差异。对B组WT患儿中的Ⅰ期各型、Ⅱ期FH型肿瘤位于患肾一极和Ⅴ期WT患儿进行保肾治疗后，肾切除率从A组的19.1%(Ⅰ～Ⅳ期)和50%(Ⅴ期)分别下降为10.5%和30%，显著增加了保留部分患肾的机会与残肾量，改善了患儿生存质量。保肾治疗不影响患儿的肿瘤复发率。【结论】 术前准确的分期分型诊断与合适的化疗是保肾治疗的关键，多学科协作诊治能显著改善WT患者的疗效;对符合保肾治疗指征的儿童WT患者进行保肾治疗, 能改善WT患儿生存质量。 　　【关键词】 肾母细胞瘤; 诊断，治疗; 保肾治疗 　　Salvage Procedure in Childrens Nephroblastoma 　　SU Cheng1, YE Gen-rong2, LI Sui-sheng1, PAN Cui-ling1, LIU Tang-bin1, ZHAN Wen-hua1 　　( Department of Pediatric Surgery, The First Affiliated Hospital, SUN Yat-sen University, Guangzhou 510080, China; 　　2. Department of Surgery, Dongguan Peoples Hospital, Dongguan 523108, China ) 　　Abstract: 【Objective】 To investigate the methods for improvement of long-term survival rate, kidney salvage rate, and survival life quality of children with Wilms tumor (WT).【Methods】 Two hundred and sixty-one cases of WT were divided into A and B groups based on the different diagnosis and treatment protocol.【Results】Patients of stage 1 (FH and UH), stageⅡ(FH), and stageⅤwere put into WT salvage procedure and the nephrectomy rate was reduced from 19.1% (Group AⅠ-Ⅳ) and 50% (stage Ⅴ) to 10% and 30%, respectively. In group A, diagnosis for WT briefly depended on X-ray study or ultrasonic exam and treatment almost relied on surgical procedure while chemotherapy and radiotherapy were irregular and incomplete. In group B, histological and cellular study as well as clinical staging were emphasized for the diagnosis, and managements was based on the diagnosis and staging individually. Out-comes of group B were improved in long-term survival rate, kidney salvage rate, complications, and survival life