小儿神经母细胞瘤32例临床分析

目的:分析小儿神经母细胞瘤(NB)的临床特点,以提高NB的早期诊断率,减少误诊。方法:回顾性分析32例NB患儿的临床特点和误诊原因。结果:(1)本组NB最常见的临床表现为腹痛腹胀(75%)、腹部包块(75%)、骨痛或关节痛(68.8%)、发热(62.5%)、贫血(62.5%);(2)本组NB原发部位以腹部最多见(其中原发于腹膜后交感神经链者12例、原发于肾上腺者10例),原发于纵隔者2例,原发于盆腔者2例,原发部位不明6例;(3)NB易早期转移,本组病例确诊时已转移者占87.5%,最常见的转移部位为骨髓(65.6%)、淋巴结(31.3%)、肝脏(25%),少见部位为脊髓及肺脏。(4)本组NB误诊率高达40.6%,常误诊为白血病(30.8%)、类风湿疾病(23.1%)、畸胎瘤(15.4%)、恶性淋巴瘤、韩-薛-柯病等;(5)本组NBCT检查发现NB阳性率88.9%,腹部B超发现病灶阳性率70.8%,尿VMA阳性率仅44.4%。结论:早期行B超和CT检查有助于发现NB原发病灶,减少误诊率。骨髓细胞学检查对发现NB转移和分期很重要,应作为NB常规检查项目。尿VMA检测阳性者对诊断NB诊断有较大意义,但阴性则不能排除NB。

Analysis of Clinic Characteristics of 32 Patients with Neuroblastoma

Objective: To analyze the clinical features of neuroblastoma(NB),so as to improve the early diagnosis for NB and decrease the rate of misdiagnosis.Methods: 32 patients with NB were analyzed by the method of retrospective study.Re-sults:(1) The common clinical manifestations of NB in our patients were as follows: abdominal pain or distension(75%),ab-dominal mass(75%),ostealgia or arthralgia(68.8%),fever(62.5%) and anemia(62.5%).(2) the most common prima-ry foci of NB was found in abdomen(12 cases originated from retroperitoneal sympathetic line and 10 cases from adrenal gland)while only 2 cases originated from mediastinum and 2 cases from pelvic cavity.There were 6 cases from unknown sites.(3) NBpatients in this group were usually found metastasis at the time of diagnosis(87.5%).The common metastatic sites were bonemarrow(65.6%),lymph nodes(31.3%) and liver(25%),while spinal cord and lung were rare metastatic sites.(4) Mis-diagnosis incidence in our patients were as high as 40.6% and they were usually misdiagnosed as leukemia(30.8%),rheuma-toid disease(23.1%),teratoma(15.4%),lymphoma(7.7%),Hand-Schuller-Christian disease(7.7%) and so on.(5) The positive incidences of laboratory examination in our NB patients were CT(88.9%),abdominal ultrasonography(70.8%) and urine VMA(44.4%),respectively.Conclusion: CT and ultrasonography should be early operated and they arehelpful for finding nidi and decreasing misdiagnosis.Bone marrow examination is useful in finding NB metastasis and the diseasestaging.Elevated level of urine VMA is vital for diagnosis of NB,but NB can not be excluded if the results are negative.