12岁少儿胃癌一例并文献复习

目的探讨少儿胃癌的诊断及治疗以提高诊疗水平。方法总结福建医科大学附属协和医院胃外科于2011年12月17日收治的1例经胃镜确诊的少儿胃癌患者的临床及病理资料；查阅1995年1月至2011年12月间发表的关于少儿胃癌的文献．具体检索福建医科大学图书馆网页MEDLINE、EMBBASE及The Cochrane Library等数据库．检索词为“Children／Pediatricgastriccancer／careinoma”：检索福建医科大学图书馆网页中文期刊全文数据库（CNKI）及中国生物医学期刊文献数据库（CMCC），检索词为“少儿胃癌”；对少儿胃癌的发病情况、临床表现、治疗及预后进行分析。结果本例患儿12岁，女性。肿瘤位于胃体高位大弯侧近胃底部．予以腹腔镜辅助根治性全胃切除术（D2），病理提示：胃体溃疡型印戒细胞癌，pT4N0M0，Ⅱb期。术后4d恢复肛门排气，术后9d出院。复习国内外文献共获取少儿胃癌病例15例，其中男7例，女8例，平均年龄12．7（2．5～17．8）岁。肿瘤位于贲门部5例．胃体部1例。胃窦或胃角部4例，胃窦及胃体部1例，未描述部位者4例。印戒细胞癌3例．低分化腺癌6例，中一低分化和中分化腺癌2例，黏液腺癌2例，不清2例。手术治疗11例，围手术期化疗8例。随访9例，半年内死亡4例，半年至1年内死亡4例；1例接受根治性手术和围手术期化疗的生存时间达102个月。结论少儿胃癌发病率极低，恶性度高、预后差，根治性手术是最重要的治疗手段，围手术期化疗可能有助于改善预后。

Gastric carcinoma in a 12-year-old girl: a case report and literature review

Objective To report the diagnosis and treatment experience of pediatric gastric cancer. Methods Clinicopathological data of a girl with gastric carcinoma in December 2011 was analyzed retrospectively. The literatures were reviewed. The disease onset, clinical manifestations, treatment, and prognosis of the patient with gastric carcinoma were studied. Results The patient was a 12-year-old gift, and the tumor was located in greater curvature. The girl underwent laparoscopy-assisted radical total gastrectomy （D2）. Pathological examination showed gastric ulcerative signet-ring cell cancer （pT4NOM0, stage Ⅱ b）. The outcome at the recent follow up was satisfactory. Literature review demonstrated 15 cases of pediatric gastric carcinoma, of whom 7 were boys and 8 girls. Their average age was 12.7 years（2.5-17.8 years）. Tumor locations included cardia（n=5）, gastric body（n=1）, gastric antrum or stomach comer（n=4）, gastric antrum and gastric body（n=l）, and unknown （n=4）. Histology showed signet-ring cell cancer in 4 patients, poorly differentiated in 6, moderate to poorly differentiated and moderate differentiated adenocareinoma in 2. Operation was performed in 11 cases and perioperative chemotherapy in 8 cases. Nine patients had follow-up. Four patients died within 6 months and other 4 patients survived for 6 months to one year. The survival time of one patient who underwent radical surgery and perioperative chemotherapy was 102 months. Conclusions Pediatric gastric carcinoma is extremely rare. It is highly malignant and associated with poor prognosis. Radical surgery is the most important treatment. Perioperative chemotherapy may improve the prognosis.