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目的探讨一种有效切除腹部神经母细胞瘤(NB)的方法和程序。方法收集2005年3月-2011年8月本院小儿外科收治且手术的腹部NB患儿40例。年龄6个月～13岁2个月。国际NB系列研究组织(INSS)分期:Ⅰ期4例,Ⅱ期3例,Ⅲ期13例,Ⅳ期20例。对所有患儿进行术前CT影像评估、一致的肿瘤切除方法即骨骼化血管和网格样切除、腹膜后淋巴结清扫3个程序,对其结果进行分析。结果肿瘤的完全切除率为97.5%,10例患儿左肾或右肾被切除,手术持续时间1 h 5 min～10 h 50 min,平均4 h 22 min;术中出血量为50～1 200 mL,平均400 mL;术中输血0～1 200 mL,平均280 mL。术后7例患儿发生并发症,其中1例患儿死亡,1例患儿右上腹出现少量包裹性积液,2例出现乳糜腹水,3例出现腹泻。无肾萎缩、血管破裂、肠梗阻、切口感染等并发症。结论通过建立标准化的程序,能使大部分患者肿瘤安全、快速和完全地切除,并发症少。腹部NB手术的程序化有利于临床医师更容易掌握这门技术。
Objective To explore a method and procedure for effective ablation of abdominal neuroblastoma (NB). Methods A total of 40 children with abdomen NB who were treated and treated in our hospital from March 2005 to August 2011 were collected. Age 6 months to 13 years 2 months. The International NB Series of Research Organizations (INSS) were divided into 4 stages: phase I in 4 cases, stage II in 3 cases, stage III in 13 cases, and stage IV in 20 cases. All patients were evaluated by preoperative CT imaging, consistent tumor resection methods, ie, skeletal vascularization and grid-like resection, retroperitoneal lymph node dissection, and their results. Results The complete resection rate of the tumor was 97.5%. The left or right kidney was removed in 10 cases. The duration of the operation was 1 h 5 min to 10 h 50 min, with an average of 4 h and 22 min; the intraoperative blood loss was 50 to 1 200 mL, average 400 mL; intraoperative blood transfusion 0 to 1 200 mL, average 280 mL. Seven patients had postoperative complications. One patient died. One patient had a small amount of encapsulated fluid in the right upper quadrant, two cases had ascites, and three had diarrhea. There were no complications such as renal atrophy, blood vessel rupture, intestinal obstruction, and wound infection. Conclusion By establishing standardized procedures, tumors can be safely, quickly, and completely removed in most patients with fewer complications. The proceduralization of abdominal NB surgery is beneficial for clinicians to master the technique more easily.