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目的探讨腔镜手术治疗小儿肿瘤的可行性、安全性、有效性。方法 2001年1月～2009年3月,应用腔镜手术治疗小儿肿瘤45例,男27例,女18例。年龄28天～12岁(<1岁12例,≥5岁6例),肿瘤直径2～15cm。对良性肿瘤及囊性肿瘤大小不作限制;对恶性实体肿瘤,选择直径<5cm者应用腔镜进行切除。良性肿瘤35例:甲状腺肿瘤4例,腹部畸胎瘤2例,卵巢囊肿13例,肠系膜淋巴管瘤1例,肠系膜囊肿1例,腹膜后巨大囊肿1例,肾上腺腺瘤6例,胰腺囊肿1例,胰腺胰岛素瘤1例,肾囊肿2例,纵隔肿瘤3例,肿瘤直径3～15cm,(7.3±2.8)cm;恶性肿瘤10例:肾上腺神经母细胞瘤2例,肾母细胞瘤2例,腹部恶性畸胎瘤2例,纵隔恶性畸胎瘤1例,肺转移肿瘤3例,肿瘤直径2～5cm,(4.2±0.9)cm。均通过腔镜行肿瘤切除术,术中冰冻病理确诊,对良性肿瘤实施肿瘤完整切除,对恶性肿瘤采用根治性切除。结果 45例全部手术成功,无中转开放手术,无不能完整切除者。手术时间30～185min,(112.6±41.7)min。出血量5～50ml,无输血病例。手术后第1～3天进食水,住院时间平均3～10d(6.5±2.5)d。术后无并发症发生。无围手术期死亡。术后病理回报肿瘤切除完全,边缘无肿瘤组织残留。术后随访6个月～8.5年,35例良性肿瘤均健康生存,无肿瘤复发;10例恶性肿瘤中8例仍健康生存,2例肝母细胞瘤肺转移患儿术后5、10个月因多发转移死亡。结论应用腔镜手术治疗小儿良性、囊性肿瘤及直径<5cm的恶性实体肿瘤可行、安全、有效。
Objective To investigate the feasibility, safety and effectiveness of endoscopic surgery for pediatric tumors. Methods From January 2001 to March 2009, 45 cases of pediatric tumors were treated with endoscopic surgery, 27 males and 18 females. Aged 28 days to 12 years (<1 years old in 12 cases, ≥ 5 years old in 6 cases), tumor diameter 2 ~ 15cm. For benign tumors and cystic tumors size is not limited; for solid tumors, the choice of diameter <5cm were removed by endoscopy. 35 cases of benign tumor: thyroid tumor in 4 cases, 2 cases of abdominal teratoma, 13 cases of ovarian cysts, 1 case of mesenteric lymphangioma, 1 case of mesenteric cyst, 1 case of retroperitoneal cyst, 6 cases of adrenal adenoma, pancreatic cyst 1 1 case of pancreatic insulinoma, 2 cases of renal cyst, 3 cases of mediastinal tumor, 3 ~ 15 cm in diameter, (7.3 ± 2.8) cm; 10 cases of malignant tumor: 2 cases of adrenal neuroblastoma, 2 cases of nephroblastoma 2 cases of malignant teratoma in abdomen, 1 case of malignant teratoma of mediastinum, 3 cases of lung metastasis and 2 ~ 5 cm in diameter of tumor (4.2 ± 0.9) cm. All patients underwent endoscopic tumor excision, intraoperative frozen pathology, complete resection of benign tumors and radical resection of malignant tumors. Results All the 45 cases were successful in operation. There was no transfer to open surgery and no complete resection was possible. The operation time was 30 ~ 185min, (112.6 ± 41.7) min. Bleeding volume 5 ~ 50ml, no blood transfusion cases. The first 3 days after surgery, eating water, hospital stay an average of 3 ~ 10d (6.5 ± 2.5) d. No postoperative complications. No perioperative deaths. Postoperative pathological findings Complete resection of the tumor, the edge of the tumor-free tissue residue. All patients were followed up for 6 months to 8.5 years. All the 35 benign tumors survived without tumor recurrence. Eight of 10 malignant tumors survived well, and 2 of 5 patients with metastasis of hepatoblastoma at 5 and 10 months after operation Due to multiple deaths. Conclusion The application of endoscopic surgical treatment of children with benign, cystic tumors and malignant solid tumors <5cm in diameter is feasible, safe and effective.