45例儿童神经母细胞瘤临床分析

目的总结分析45例儿童神经母细胞瘤（NB）患儿的临床特点及预后。方法 45例神经母细胞瘤患儿的临床资料,分析临床表现、临床分期及治疗情况。通过复诊、电话、信访等方式了解患儿术后预后情况。结果 45例神经母细胞瘤患者中75.0%的发病年龄在3岁以下,男女之比为2：1,肿瘤原发于肾上腺28例（62.2%）,后腹膜5例（11.1%）,颈部6例（13.3%）,纵隔6例（13.3%）,首发症状为腹部肿物者38例（84.4%）,伴有腹痛30例（66.6%）,腹胀20例（44.4%）,胸腔积液6例（13.3%）,伴有发热10例（22.2%）。就诊时远处转移12例（26.6%）,其中肺转移5例（6.4%）,肝转移7例（5.1%）。45例患儿中行尿香草扁桃酸VMA定量检测〉30 mg/24 h者30例（78.9%）,45例行血清NSE检测,〉100 ng/L者41例（91.1%）,29例行甲胎蛋白（AFP）定性检测,均为阴性,30例行血清乳酸脱氢酶（LDH）检测,其中〉700 U/L者25例（83.3%）。生存情况：8例无瘤生存,14例带瘤生存,9例因术后放弃化疗而死亡,9例因病情恶化或者复发死亡,1年生存率：81.6%,2年生存率53.5%,5年生存率12.8%。结论神经母细胞瘤以3岁以内发病率高,男性多于女性,首发症状为腹部肿物,可伴有发热等症状,检测VMA、血液神经元特异性烯醇化酶（NSE）及LDH有助于NB的早期诊断,同时要加强医患沟通,坚持完成化疗,提高患儿生存率。

Clinical analysis of 45 cases of children with neuroblastoma

Objective To summarize the clinical characteristics and prognosis of 45 cases of children with neuroblastoma to improve the understanding of clinical characteristics and prognosis of neuroblastoma. Methods Retrospectively analyzed clinical data of 45 cases of neuroblastoma, analyzed clinical manifestations, clinical staging and treatment by checking the clinical data, understood the prognosis of children with postoperative follow-up through telephone, letters to get children＇s postoperative prognosis. Results 75% patients with neuroblastoma under 3 years old, the male to female ratio was 2：1, 28（62.2%） cases of primary tumor in the adrenal, 5 cases（11.1%） of retroperitoneal, 6 cases（13.3%） of neck, 6 cases（13.3%） of mediastinal, 38 cases（84.4%） of abdominal symptoms mass, 30 cases（66.6%） with abdominal pain, 20 cases（44.4%） of abdominal distension, 6 cases（13.3%） of pleural effusion. 10 cases（22.2%） of fever. 12 cases（26.6%） of distant metastasis, including 5 cases（6.4%） of lung metastasis, 7 cases（5.1%） of liver metastasis. Detection of 30 cases of children with VMA, of quantitative 30 mg/24 h in 45 cases（78.9%）, 45 cases of detection of neuron specific enolase（NSE）, and 41 cases（91.1%） of 100 ng/L, 29 cases of alpha fetoprotein（AFP） with qualitative detection, were negative, 30 cases of lactate dehydrogenase（LDH） detection, the〉700 μ/L in 25 cases（83.3%）. Survival： 8 cases survived without tumor, 14 cases survived with tumor, 9 cases of postoperative dead due to give up chemotherapy, 9 cases of death due to disease progression or relapse, 1 year survival rate was 81.6%, 2 year survival rate was 53.5%, 5 year survival rates was 12.8%. Conclusion Neuroblastoma has a high incidence rate in children under 3 years old, more male than female, the first symptom was abdominal mass, may be associated with fever and other symptoms, detection of urine VMA, blood NSE and LDH help early diagnosis of NB, at the same time to strengthen the commun