儿童肾母细胞瘤临床特点及误诊分析

Analysis of clinical characteristics and misdiagnosis in child Patients with Wilms' tumor

关键词:  儿童  肾母细胞瘤  诊断  治疗

Key words:  children  wilms tumor  diagnosis  treatment

摘要:

探讨小儿肾母细胞瘤临床特点 及误诊原因。［方法］ 对西安交通大学第一医院1971～2002年收治的87例肾母细胞瘤患儿 进行回顾性分析。［结果］ 发病年龄2个月～14岁 ， 平均就诊年龄（49.06±32.20）月，其中男性多于女性，左侧多于右侧，双侧少见， 8. 05%有家族遗传史。Ⅱ期、Ⅲ期病例占多数，误诊率高。Kaplan-Meier作单因素分析提示临 床分期越晚，生存期越短；综合治疗显著优于单纯治疗。Cox风险比例模型分析表明临床分 期和治疗方式是影响预后的重要因素。早期症状不明显及对本病认识不足是肾母细胞瘤最可 能的误诊原因。 ［结论］ 定期普查5岁以下儿童，争取早期发现和早诊断，采用个体化综 合治疗方案可提高患儿生存率。

Abstract:

To analyze the clinical characterist ics and misdiagnosis i n child patients with Wilms'tumor. ［Methods］ Patients with Wilms'tumor of 87 ca ses were retrospectively analyzed by spss 10.0. ［Results］ The range of age was from 2 months to 14 years, average being (49.06±32.20) months. The incidence o f the tumor in male and left-side were higher than those in female and right-side, an d bilateral tumors were rare. The rate of positive family history was 8.05%. The most of the tumors were found in Stage Ⅱand stage Ⅲ. Kaplan-Meier showed that patients of the earlier stages and combined therapy had longer survival time th an those of later stages and single therapy. Cox regression suggested that clini cal stages and therapeutic methods were related to the prognosis of the patients . Untypical symptom in earlier period and physicians lacking of experiences may result in misdiagnosis. ［Conclusion］ It is necessary to survey children unde r 5 years old periodicaly for early detection, and multidisciplinary approach shou ld be emphasized on the treatment of the specific patients with Wilms' tumor in order to improve survival rate