Cañete A, Jovani C, Lopez A, Costa E, Segarra V, Fernández J M, Verdeguer A, Velázquez J, Castel V
Pediatric Surgery Department, Hospital Infantil La Fe, Valencia, Spain.
J Pediatr Surg. 1998 Oct;33(10):1526-30. doi: 10.1016/s0022-3468(98)90490-0.
BACKGROUND/PURPOSE: Surgery plays an important role in neuroblastoma treatment. Although influence of resectability in survival has been studied deeply, reports about surgical complications are scant. The authors analyze retrospectively their experience in neuroblastomas (NB) diagnosed from 1980 to 1995.
Clinical variables such as age, stage, location, presurgical chemotherapy, type, and extent of surgery were studied. Complications were classified according to the following criteria: time, type of surgery, and extent of resection.
Seventy-eight NB patients had surgery performed in our hospital. Mean age at diagnosis was 2.4 years (range, 0 to 11 years); 33 patients were under 1 year of age. Sixty-eight percent of the patients had advanced disease. Abdominal tumors were predominant. Sixty-three percent of the patients had chemotherapy before surgery, with shrinkage of the tumor in most of the cases (88%). Eighty-six surgical procedures were performed, 29 initially and 57 delayed. Complete resection was reached in 52 patients, partial in 19 patients, and seven patients underwent biopsy only. There were 42 surgical complications. Three of them were considered extremely serious (one death caused by cardiac arrest, one tumoral rupture, and one great vessel injury). Nephrectomies (n = 12) were the most frequent intraoperatory complications. Bernard-Horner syndrome (n = 5) and pleural effusions (n = 5) predominated in the postoperative period.
(1) Surgery in NB can be performed safely. (2) Nephrectomies can be necessary to achieve complete resection in some abdominal tumors. (3) Nephrectomies, Bernard-Horner syndrome, and pleural effusions were the most frequent complications in our patients. (4) Presurgical chemotherapy can lead to a wider and safer removal of locally advanced tumors.
背景/目的：手术在神经母细胞瘤治疗中起着重要作用。尽管可切除性对生存率的影响已得到深入研究，但关于手术并发症的报道却很少。作者回顾性分析了他们在1980年至1995年间诊断出的神经母细胞瘤（NB）的治疗经验。
研究了年龄、分期、位置、术前化疗、手术类型和范围等临床变量。并发症根据以下标准分类：时间、手术类型和切除范围。
78例NB患者在我院接受了手术。诊断时的平均年龄为2.4岁（范围0至11岁）；33例患者年龄在1岁以下。68%的患者患有晚期疾病。腹部肿瘤最为常见。63%的患者在手术前接受了化疗，大多数病例（88%）肿瘤出现缩小。共进行了86次手术，其中29例为初次手术，57例为延迟手术。52例患者实现了完全切除，19例患者部分切除，7例患者仅接受了活检。共有42例手术并发症。其中3例被认为极其严重（1例因心脏骤停死亡，1例肿瘤破裂，1例大血管损伤）。肾切除术（n = 12）是最常见的术中并发症。术后以Bernard-Horner综合征（n = 5）和胸腔积液（n = 5）最为常见。
（1）NB手术可以安全进行。（2）对于某些腹部肿瘤，为实现完全切除可能需要进行肾切除术。（3）肾切除术、Bernard-Horner综合征和胸腔积液是我们患者中最常见的并发症。（4）术前化疗可使局部晚期肿瘤的切除范围更广、更安全。
