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目的 探讨小儿恶性肿瘤术后复发或转移的影响因素和治疗。方法 回顾性分析1 999年 1月～ 2 0 0 2年 6月间收治的 41例 1 1个月～ 1 5岁的小儿恶性肿瘤术后复发或转移病例 ,其中1岁以下 2例、1～ 3岁 8例、4～ 6岁 1 1例、7～ 9岁 7例、1 0岁以上 1 3例。病理类型为神经母细胞瘤1 2例、软组织肉瘤 1 0例 (横纹肌肉瘤 7例、纤维肉瘤 3例 )、肾母细胞瘤 7例、生殖细胞恶性肿瘤 4例(骶尾部恶性畸胎瘤 2例、卵巢内胚窦瘤 1例 )、肝脏恶性肿瘤 3例 (肝脏肉瘤 2例、肝母细胞瘤 1例 )、其他恶性肿瘤 5例 (肾癌 2例、甲状腺癌、眼眶未分化癌、上肢恶性神经鞘瘤各 1例 )。首次手术时的临床分期为Ⅰ期 4例、Ⅱ期 1 2例、Ⅲ期 1 1例和Ⅳ期 1 4例。报道术后复发或转移的治疗及结果。结果 无论直接手术、再次手术或化疗后肿瘤根治术 ,至 2 0 0 2年 9月随访结果 ,存活率均达 80 %以上 ,以CT、B超及临床检查均无复发或转移为无瘤生存标准。原位复发 2 4例 (58.5 % ) ,术后远处转移 1 7例。首次手术肿瘤残留、肿瘤病理类型是术后复发或转移的主要影响因素。 2 2例 (53 .6 % )接受再次肿瘤根治术 ,存活率 80 % ,平均生存 (31 .6± 1 7.8)个月。 1 3例予化疗 ,至今无瘤生存 2 1例 (56 .8% ) ,平均生存时间 (2 3 .45± 1
Objective To investigate the influential factors and treatment of recurrence or metastasis of pediatric malignant tumor after operation. Methods A retrospective analysis of 41 cases of children with recurrent or metastatic lesions of children with malignant tumors of 11 months to 15 years old admitted between January 1999 and June 2002 was performed. Among them, 2 cases under 1 year old and 1 ~ 8 cases were 3 years old, 11 cases were 4 ~ 6 years old, 7 cases were 7 ~ 9 years old and 13 cases were over 10 years old. Pathological types were 12 cases of neuroblastoma, 10 cases of soft tissue sarcoma (7 cases of rhabdomyosarcoma, 3 cases of fibrosarcoma), 7 cases of nephroblastoma, 4 cases of germ cell malignant tumor (2 cases of sacrococcygeal teratoma , 1 case of ovarian endodermal sinus tumor), 3 cases of liver malignancies (2 cases of liver sarcoma, 1 case of hepatoblastoma), 5 cases of other malignant tumors (2 cases of renal cell carcinoma, thyroid carcinoma, orbital undifferentiated carcinoma, Schwannoma in 1 case). The clinical stage of the first operation was stage Ⅰ in 4 cases, stage Ⅱ in 12 cases, stage Ⅲ in 11 cases and stage Ⅳ in 14 cases. Report postoperative recurrence or metastasis of the treatment and results. Results No matter direct surgery, reoperation or radical nephrectomy after chemotherapy, the survival rate reached more than 80% up to September 2002 follow-up, and no recurrence or metastasis was found by CT, B ultrasound and clinical examination. standard. In situ recurrence in 24 cases (58.5%), distant metastasis in 17 cases. The first surgical residual tumor, tumor pathological type of postoperative recurrence or metastasis of the main influencing factors. Twenty - two patients (53.6%) underwent radical resection of the tumor with a survival rate of 80% and an average survival of (31.6 ± 7.8 months). 13 cases were given chemotherapy, so far no tumor-free survival in 21 cases (56.8%), mean survival time (23.5 ± 1