80例儿童实体瘤肺转移的手术治疗分析

目的探讨儿童实体瘤肺转移的手术方法及围手术期管理经验。方法回顾性分析2012年1月至2018年12月中国人民解放军总医院第七医学中心八一儿童医院收治的80例实体瘤肺转移患儿的临床资料及随访资料。总结分析上述患儿的术中情况、手术并发症和治疗结局。结果共行肺转移瘤切除术80例/114次,其中58例(72.5%)患儿仅实施一次手术,二次手术13例(16.25%),三次手术6例(7.5%),四次手术3例(3.75%)。中位随访时间30个月(0.4~76个月),死亡28例,其中21例(75%)为肿瘤复发转移,7例(25%)为非肿瘤性死亡(包括2例围手术期死亡病例)。采用Kaplan-Meier法计算本组患儿术后1年、3年、5年累积生存率分别为88.8%,81.0%,58.6%,术后1年、3年、5年累积无事件生存率分别为88.8%,74.5%,52.1%。结论部分实体瘤肺转移患儿能够从手术中获益,肺转移手术的并发症可以得到有效控制,术中应遵循仔细探查和尽量切净的原则。

Surgical treatment of pulmonary metastases in pediatric solid tumors:a report of 80 cases

Objective To explore the surgical approaches and perioperative managements of pulmonary metastases in pediatric solid tumors.Methods Retrospective analysis was performed for the clinical data of 80 hospitalized children with pulmonary metastases of solid tumors from January 2012 to December 2018.Intraoperative findings,complications and outcomes were analyzed.Results A total of 114 resections of lung metastatic tumors were performed.The operative frequency was once(n=58),twice(n=13),thrice(n=6)and fourth(n=3).The median follow-up period was 30(0.4-76)months.Among 28 deaths,21(75%,21/28)were due to tumor recurrence and metastasis and 7(25%,7/28)non-tumor causes.The latter included 2 perioperative deaths.The rates of cumulative overall survival(OS)at 1/3/5 year were 88.8%,81.0%and 58.6%respectively by Kaplan-Meier method and cumulative event-free survival(EFS)at 1/3/5 year 88.8%,74.5%and52.1%respectively.Conclusion Some children with pulmonary metastatsectomy in solid tumors may benefit from surgery.And the safety and complications of pulmonary metastases can be controlled.The principles of thorough exploration and complete resection should be followed.