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【目的】探索儿童肾母细胞瘤(WT)保肾治疗方案和提高WT患儿长期生存率、改善生存质量的诊疗方案。【方法】根据诊治方案不同,将我院261例WT患儿分为A、B两组,通过比较A、B两组的疗效,分析外科、病理、影像、化疗、放疗等学科在提高WT疗效,改善长期生存质量中的作用以及多学科协作综合治疗对保肾治疗的作用。【结果】A组WT诊治以影像学诊断+手术治疗为主,B组WT诊治强调明确的病理分型与临床分期以及个体化的多学科综合治疗方案。A、B两组WT患儿在2年/5年生存率、保肾治疗率、手术并发症及长期生存质量等方面均存在显著差异。对B组WT患儿中的Ⅰ期各型、Ⅱ期FH型肿瘤位于患肾一极和Ⅴ期WT患儿进行保肾治疗后,肾切除率从A组的19.1%(Ⅰ～Ⅳ期)和50%(Ⅴ期)分别下降为10.5%和30%,显著增加了保留部分患肾的机会与残肾量,改善了患儿生存质量。保肾治疗不影响患儿的肿瘤复发率。【结论】术前准确的分期分型诊断与合适的化疗是保肾治疗的关键,多学科协作诊治能显著改善WT患者的疗效;对符合保肾治疗指征的儿童WT患者进行保肾治疗,能改善WT患儿生存质量。
【Objective】 To explore the treatment of kidney nephroblastoma (WT) and to improve the long-term survival rate and quality of life in children with WT. 【Methods】 According to different diagnosis and treatment plans, 261 WT patients in our hospital were divided into A and B groups. By comparing the curative effects of A and B groups, we analyzed the effects of surgery, pathology, imaging, chemotherapy and radiotherapy on the improvement of WT efficacy , The role of improving long-term quality of life and the effect of multidisciplinary and comprehensive treatment on the treatment of kidney-tonifying. 【Results】 The diagnosis and treatment of WT in group A were mainly imaging diagnosis and surgical treatment. The diagnosis and treatment of WT in group B emphasized the definite pathological classification and clinical staging as well as individual multidisciplinary comprehensive treatment plan. A, B two groups of children with WT in 2 years / 5-year survival rate, treatment rate, complications and long-term quality of life there are significant differences. In group B, there was 19.1% (Ⅰ ~ Ⅳ) patients in group A with 19.1% (A ~ Ⅳ) of nephrectomy after type Ⅰ and type Ⅱ FH tumors were located in patients with WT and Ⅴ of WT. And 50% (Ⅴ) decreased to 10.5% and 30% respectively, which significantly increased the chance of remaining part of the kidney and residual kidney volume, and improved the quality of life of the children. Kidney does not affect the treatment of children with tumor recurrence rate. 【Conclusion】 Accurate preoperative staging and diagnosis and appropriate chemotherapy are the key to protecting kidney. Multidisciplinary collaborative diagnosis and treatment can significantly improve the curative effect in patients with WT. In children with WT indications, Can improve the quality of life of children with WT.