| Background and objectivesNeuroblastoma is the most common extracranial substantive malignant tumor in children.Its annual incidence is0.3/100000-5/100000.It originates from the adrenal medulla or paravertebral sympathetic nervous system of the immature embryo cells.It develops in children aged1to5,male children with slightly more than female.adrenal gland is one of the most common, followed by retroperitoneal,and mediastinal,the distribution of the pelvic and cervical sympathetic ganglion cells.It’s high malignant degree, and lack of characteristic symptoms,and easy to misdiagnose.It can be easily transferred to the lymph nodes, bone marrow, skin, liver, kidney and bone tissue in early.It has the characteristics of spontaneous regression and differentiation in vitro.Because children have disease is hidden, part of tumors has larger when children see a doctor,and can’t be complete resected.As the new chemotherapy regimens and biological treatment in the application of neuroblastoma, the survival rates of children with neuroblastoma has been greatly improved.In this study the clinical data of80children with neuroblastoma were analyzed.The relevant literatures were reviewed.This provides certain reference basis to the diagnosis of neuroblastoma in the future.MethodsIn this study the clinical data of80children with neuroblastoma were analyzed.The relevant literatures were reviewed.54cases of male, female are26cases, the age are6months to8years old, the average is3years old.Among these patients56cases were in the abdomen,12cases were in the Mediastinum,12cases were in the neck.64patients have different degree of anemia,40cases have painless abdominal mass, abdominal distension,and loss of appetite.All patients were found the bag piece after complete examination,the tumors had different sizes,the tumors’s activity is poorer and it had no clear boundary to the surrounding tissues.Postoperative INSS staging was carried out in the40surgery patients, including14cases in INSS1(17.5%),16cases in INSS Ⅱ(20%),16cases in INSS Ⅲ(20%),32cases in INSS IV(40%),and2cases in INSS Ⅳs.Main treatment is surgery and chemotherapy. All the80patients underwent surgery.50cases of children with primary tumor is small, no distant metastasis, tumors resection were first, then the multi-drug combination chemotherapy were done.The tumors of30cases were too big to operate,in this case,the multi-drug combination chemotherapy were first.Patients were followed up by clinic visits, letters or phone calls. Data was analyzed using SPSS17.0, survival curve was analyzed using Kaplan-Meier, and survive rate significance was tested using Log-rank. A P value of less than0.05was considered statistically significant.ResultsAll the80patients underwent surgery.50cases of children with primary tumor is small, no distant metastasis, tumors resection were first, then the multi-drug combination chemotherapy were done.The tumors of30cases were too big to operate,in this case,the multi-drug combination chemotherapy were first.80cases underwent surgical treatment, complete removal were72cases(90%),no operative deaths. Surgical complications included renal vascular injury in2cases, vena cava rupture in1case, chyle in1case, postoperative abdominal adhesion ileus in2cases.Renal vascular injury and vena cava fracture all were taken vascular anastomosis successfully.Chyle, postoperative abdominal adhesion sex intestinal obstruction patients were given the conservative cure such as fasting, gastrointestinal decompression, the children returned to normal.A total of80cases with complete chemotherapy, chemotherapy drugs include cyclophosphamide, anthracycline-based and platinum aperiodic specificity anti-tumor medicine.Chemotherapy side effects include loss of white blood cells, anemia, thrombocytopenia, and severe infection, gastrointestinal bleeding. with the increase of number of chemotherapy, patients bone marrow recovery time also increases accordingly, usually need1to2weeks,4weeks the most elderly people.All children after treatment for every3-12months follow-up time, follow-up content includes children with or without abdominal discomfort, colour to exceed, periodic review of CT with and without recurrence, review of routine blood, liver and kidney function, urine vanilla mandelic acid, iron, protein, lactate dehydrogenase, neuron specificity enolization enzymes and other biochemical indicators.The most elderly people for five years.This group of80cases were followed up to64cases of effective information,16patients were lost to follow-up, the follow-up rate was80%,2-55months follow-up time.survive38cases,3cases postoperative relapse again do surgery.ConclusionSurgery is still the main treatment of neuroblastoma,for huge primary tumors, a transfer to the children of the operation can be directly in the distance of chemotherapy.On the timing of surgery based on each course to evaluate tumor,Shrink tumors generally reach a plateau after three or four courses,so we generally take a evaluation after four courses.surgical exploration will be done if we could have a complete tumor resection. Surgery’s goal is to remove all visible and can be reached in malignant tissue, and strive to achieve complete resection under the naked eye.If we estimate that the tumor cannot be completely removed,another four courses of chemotherapy will be given.Prognosis of neuroblastoma is mainly related to the following factors:children less1year old have a high rate of complete resection and a better prognosis,tumors in outside adrenal and Diaphragmatic area have a better prognosis,stage in INSS I and INSS II have a better prognosis than stage in INSS III and INSS IV,the more the MYCN gene expressed, the poorer the prognosis is.The curative effect will be better if Shimada histopathological type is better type.Anyhow, neuroblastoma will have a relatively better prognosis if it can be early diagnosed and treated timely. |
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