肾母细胞瘤复发和转移后的再手术治疗

目的 探讨肾母细胞瘤复发和转移后的再手术治疗.方法 回顾分析2000至2008年期治疗后的15例肾母细胞瘤复发和转移病例,记录其相关的病例资料及肿瘤复发的时间、复发部位、肿瘤复发后的手术治疗方案,并统计再治疗后的随访结果.结果 肿瘤复发和转移时间3个月～5年(中位时间7个月).病理类型FH 13例,UH 2例,NWTSG分期Ⅱ期4例,Ⅲ期5例,Ⅳ期3例,另有3例资料不完整.5例有术前或术中肿瘤破溃史(33%),有6例术后未按照规范化治疗(40%).9例复发肿瘤行再次手术,术式为单纯肿瘤切除,术后再行化疗和放疗,再次手术后1年总体生存率为67.7%,2年总体生存率为57.1%,2年无瘤生存率42.9%,生存时间较非手术病例明显延长(P<0.05).结论 肿瘤破溃与不规范治疗是肾母细胞瘤复发的重要因素.对复发肿瘤行积极的手术切除具有重要意义,结合综合治疗有助于提高复发肿瘤治愈率.

There-operation of recurrent Wilm's tumour

Objective To evaluate re-operation of the recurrent of Wilms'tumor.Methods A retrospective study was carried out in 15 cases of recurrent Wilms'tumor operated in our hospital between January 2000 and November 2008.Results The time of recurrence ranged from 3 months to 5 years (the median time is 7 months) after the initial operation.There were 3 cases of favourable histological type and 2 cases of unfavourable histological type.According to the NWTS classification system,there were 4 cases of stage Ⅱ,5 cases of stage Ⅲ,3 cases of stage Ⅳ,another 3 cases can't be clearly classified because of incomplete records.Five patients' tumor (33%) had tumor spill either before hospital admission or during the operation.Six patients (40%) had non-standardized chemotherapy.Nine patients consented to the second operation.The 1 year overall survival of these 9 cases was 67.7%,the 2 years overall survival was 57.1%,the 2 years event free survival was 42.9%.The survive time is significant lengthened than the other 3 patients which did not accept the second operation,Conclusions Both the spillage of tumor and non-standardized chemotherapy are the major cause of Wilms'tumor relapse.The re-operation is useful.