Yang Li,Xu Sheng,Yang Binyi,et al.Diagnosis and treatment of adrenal-region tumors in children:an analysis of 72 cases[J].Journal of Clinical Pediatric Surgery,2026,(09):859-862.[doi:10.3760/cma.j.cn101785-202411029]
儿童肾上腺区肿瘤72例诊疗分析
- Title:
- Diagnosis and treatment of adrenal-region tumors in children:an analysis of 72 cases
- Keywords:
- Adrenal Gland Neoplasms; Diagnosis; Therapy; Prognosis; Surgical Procedures; Operative; Child
- 摘要:
- 目的 探讨儿童肾上腺区肿瘤的临床特征、诊断、治疗及预后。方法 本研究为回顾性病例系列研究。以青岛妇女儿童医院及青岛大学附属医院儿童外科2009年7月至2022年5月收治的72例经手术治疗的肾上腺区肿瘤患儿为研究对象。收集患儿临床特征、诊断、治疗及预后资料。以肿瘤直径6 cm为界、手术方式分组。对于肾上腺区恶性肿瘤手术患儿，采用Kaplan-Meier法计算生存时间，预后相关因素的单因素分析采用Log-rank检验。结果 72例中，肾上腺来源肿瘤19例，肾上腺周围来源肿瘤53例（其中神经母细胞瘤23例、节细胞神经母细胞瘤13例、节细胞神经瘤10例（1例新辅助化疗前穿刺结果为神经母细胞瘤，术后病理证实转化为节细胞神经瘤）、成熟性囊性畸胎瘤5例、异位支气管源性囊肿2例）。患儿肿瘤均完整切除，无一例围手术期死亡。以肿瘤直径6 cm为界分组，<6 cm组与≥6 cm组的腔镜手术例数占比、手术时间、术后住院天数差异均无统计学意义（P> 0.05）。以手术方式分组，腔镜组和开放组的手术时间、术后住院天数差异亦无统计学意义（P>0.05），但两组恶性病例占比（39.1% 比83.0%）差异有统计学意义（P<0.01）。术后随访54例（75%），平均随访24.4个月。1例患儿术后复发，12例发生转移，3例死亡。单因素生存分析显示，手术方式与肾上腺区恶性肿瘤患儿的存活率无关（腔镜组100% 比开放组89.7%，P=0.34）。结论 儿童肾上腺区肿瘤起病隐匿，临床表现多无特异性，病理组织来源多样。影像学检查是主要诊断依据，充分术前评估与准备下的手术切除是最有效的治疗方法，多学科诊疗是提高患儿生存率的重要手段。
- Abstract:
- Objective To investigate the clinical features,diagnosis,treatment,and prognosis of adrenal-region tumors in children.Methods This was a retrospective case series study.Seventy-two children with adrenal-region tumors who underwent surgical treatment in Qingdao Women and Children’s Hospital and the Department of Pediatric Surgery of the Affiliated Hospital of Qingdao University from July 2009 to May 2022 were included.Data on clinical features,diagnosis,treatment,and prognosis were collected.The children were grouped according to a tumor diameter cut-off of 6 cm and surgical approach.For children who underwent surgery for malignant adrenal-region tumors,survival time was calculated using the Kaplan-Meier method,and univariate analysis of prognostic factors was performed using the Log-rank test.Results Among the 72 children,19 had tumors of adrenal origin and 53 had tumors of peri-adrenal origin,including 23 cases of neuroblastoma,13 cases of ganglioneuroblastoma,10 cases of ganglioneuroma (one case was diagnosed as neuroblastoma by puncture before neoadjuvant chemotherapy and was pathologically confirmed to have transformed into ganglioneuroma after surgery),5 cases of mature cystic teratoma,and 2 cases of ectopic bronchogenic cyst.Complete tumor resection was achieved in all children,with no perioperative death.When grouped by tumor diameter using 6 cm as the cut-off,there were no statistically significant differences between the <6 cm group and the ≥6 cm group in the proportion of laparoscopic surgery,operative time,or postoperative hospital stay (P>0.05).When grouped by surgical approach,there were also no statistically significant differences in operative time or postoperative hospital stay between the laparoscopic and open surgery groups (P>0.05),but the proportion of malignant cases differed significantly between the two groups (39.1% vs.83.0%,P<0.01).Postoperative follow-up was completed in 54 children (75%),with a mean follow-up duration of 24.4 months.Postoperative recurrence occurred in 1 child,metastasis occurred in 12 children,and 3 children died.Univariate survival analysis showed that surgical approach was not associated with survival in children with malignant adrenal-region tumors (100% in the laparoscopic group vs.89.7% in the open surgery group,P=0.34).Conclusion Adrenal-region tumors in children have insidious onset,mostly lack specific clinical manifestations,and have diverse pathological origins.Imaging examination is the main diagnostic basis,and surgical resection after adequate preoperative evaluation and preparation is the most effective treatment.Multidisciplinary diagnosis and treatment are important means to improve survival in affected children.
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备注/Memo
收稿日期:2024-11-13。
基金项目:山东省医药卫生科技发展计划项目（202202080942）
通讯作者:鹿洪亭,Email:luhongting@163.com