杨敏+许志建

[摘要] 目的 探讨肿瘤患儿的发病及临床就诊规律，为提高肿瘤患儿的急诊早期诊断率及减少误诊率提供科学依据。 方法 收集2014年4月～2015年3月福建医科大学附属漳州市医院儿科急诊最后确诊恶性肿瘤的资料进行统计学分析。 结果 白血病、中枢神经系统恶性肿瘤分别居第一位、第二位。0～3岁组发病率为149.44/100万，4～7岁组发病率为121.43/100万，8～14岁组发病率为102.74/100万。 结论 转换儿科急诊的诊疗思路，重视相关儿童恶性肿瘤的重要辅助检查，能缩短恶性肿瘤诊断时间，提高儿童肿瘤的早期诊断率，改善儿童恶性肿瘤的临床预后。

[关键词] 恶性肿瘤；急诊；早期诊断；白血病

[中图分类号] R730.5 [文献标识码] B [文章编号] 1673-9701（2017）16-0045-03

[Abstract] Objective To explore the pathogenesis and the visiting regularity of children with cancers， and to provide a scientific basis for improving the emergency early diagnosis rate of children with cancers and reducing the misdiagnosis rate. Methods The data of patients with final diagnosis of malignant tumors and emergency visits to the Department of Pediatrics from April 2014 to March 2015 were collected， and make a statistical analysis. Results Leukemia and central nervous system malignancies were ranked the first place and the second place. The incidence rate of 0-3 age group was 149.44/million， the incidence rate of 4 to 7 years old group was 121.43/million， and the incidence rate of 8 to 14 years old group was 102.74/million. And the first clinical manifestations of all kinds of malignant tumors were analyzed. Conclusion Conversion of pediatric emergency diagnosis， treatment ideas and attention paid to malignant tumors-related important auxiliary examination， can shorten the diagnosis time of malignant tumors， improve the early diagnosis rate of children's cancer， and can improve the clinical prognosis and the 5-year survival rate of children with malignant tumors.

[Key words] Malignant neoplasms； Emergency； Early diagnosis； Leukemia

兒童恶性肿瘤的发病率低，近年来随着医疗技术水平的不断改进，儿童肿瘤的治愈率和完全缓解率得到显著提高，据德国研究协作组统计，儿童恶性肿瘤患者总的长期治愈率超过75%[1]。而临床医师对儿童肿瘤的认识尚需提高，目前存在的主要问题是漏诊率高，容易错过最佳治疗时间。儿科急诊常见疾病多为呼吸系统疾病、消化系统疾病、神经系统疾病、法定传染病、意外伤害等，儿科急诊医师对儿童肿瘤认识程度较儿童肿瘤专科医师更低。但是我国目前儿科急诊量大，病种多，对儿童急诊医师的要求高，儿科急诊医师应不断更新知识，不仅包括儿童急诊急救，也包括儿童专科知识。为此，本研究对我院儿科急诊2014年4月～2015年3月接诊的107 069例急诊患儿中已确诊的40例恶性肿瘤患儿的疾病谱和临床特点进行回顾性总结分析，现将结果报道如下。……