Ding Zheyu,Wang Jinhu,Wang Qi,et al.Solid Tumor with hypertension and myocardial hypertrophy in children: report of 3 cases and literature review[J].Journal of Clinical Pediatric Surgery,2022,21(06):586-590.[doi:10.3760/cma.j.cn101785-202111043-017]
儿童实体肿瘤合并高血压与心肌肥厚3例诊治分析及文献复习
- Title:
- Solid Tumor with hypertension and myocardial hypertrophy in children: report of 3 cases and literature review
- 关键词:
- 高血压/病因学; 高血压/治疗; 心肌肥厚; 神经母细胞瘤/并发症; 神经母细胞瘤/外科学; Wilms瘤/并发症; Wilms瘤/外科学; 畸胎瘤/并发症; 畸胎瘤/外科学; 治疗结果
- Keywords:
- Hypertension/ET; Hypertension/TH; Myocardial Hypertrophy; Neuroblastoma/CO; Neuroblastoma/SU; Wilms Tumor/CO; Wilms Tumor/SU; Teratoma/CO; Teratoma/SU; Treatment Outcome
- 摘要:
- 目的 分析儿童肿瘤引发高血压与心肌肥厚的相关因素，并探讨其诊治策略。方法 回顾性分析浙江大学医学院附属儿童医院于2015—2020年收治的3例儿童肿瘤合并高血压与心肌肥厚患儿的临床资料，观察年龄、病理类型、肿瘤大小以及位置等与高血压及心肌肥厚发生的关系，总结其综合治疗经验与预后。结果 3例患儿发病时年龄均<1岁，均因腹部肿物就诊，均合并高血压，超声均提示明显的心肌肥厚和左室射血功能下降。3例肿瘤类型分别为神经母细胞瘤、肾母细胞瘤和畸胎瘤。均于术前予降压、强心等综合治疗，在血压相对平稳的情况下均顺利完成手术治疗。术后血压均逐步恢复正常，心肌肥厚逐步缓解，心功能逐步改善。结论 不同肿瘤可能通过不同机制引发高血压，小婴儿高血压较难早期发现，持续高血压可能引发心肌肥厚和心功能不全。切除肿瘤是缓解高血压、改善心肌肥厚及心功能的根本性治疗手段。小婴儿心肌肥厚在尽早干预下可有较大机会逆转。
- Abstract:
- Objective The purpose of the study is to analyze the related factors of hypertension and myocardial hypertrophy secondary to solid tumors in children and explore the diagnosis and treatment strategies.Methods Three cases of hypertension and myocardial hypertrophy secondary to solid tumors were admitted to Children’s Hospital Zhejiang University School of Medicine from 2015 to 2020.The treatment process and clinical data were studied retrospectively.The relationship between age, pathological diagnosis, tumor size, tumor location, hypertension and myocardial hypertrophy was analyzed.Results The onset age of the 3 cases were all under 1 year old.All 3 cases presented with abdominal mass and were diagnosed with obvious hypertension after admission Ultrasonography indicated obvious myocardial hypertrophy and decreased left ventricular ejection function.The tumor types of 3 patients included neuroblastoma, nephroblastoma and teratoma.All patients were treated with hypotension and cardiotonic therapy before operation, and the operation was successfully completed under the condition of relatively stable blood pressure.Postoperative blood pressure level gradually returned to normal, cardiac hypertrophy gradually relieved, and cardiac function gradually improved.Conclusion Hypertension could be caused by different tumors through different mechanisms.Hypertension in small infants is difficult to detect early, and persistent hypertension may lead to myocardial hypertrophy and cardiac insufficiency.Complete resection of tumor is the key step in the treatment and in relieving hypertension and improving myocardial hypertrophy and cardiac function.Myocardial hypertrophy in young infants has a good chance of being reversed by early intervention.
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备注/Memo
收稿日期:2021-11-20。
基金项目:浙江省自然科学基金青年项目（LQ20H160027）
通讯作者:舒强,Email:shuqiang@zju.edu.cn