摘要
目的探讨经导管动脉化疗栓塞术在婴幼儿肝母细胞瘤手术切除前的疗效。方法回顾性分析2007年7月至2010年7月间的15例肝母细胞瘤临床资料。所有患儿术前均行CT增强扫描及肝脏肿物穿刺活检以明确诊断。首诊后直接行外科切除术4例（Ⅰ期手术组）；首诊后难以手术切除，先予经导管动脉化疗栓塞术（TACE）11例（Ⅱ期手术组），即将导管插入肿瘤供血动脉，注入吡柔比星（30mg／m^2）＋顺铂（60mg／m^2）＋超液化碘油形成的乳剂，最后用聚乙烯醇颗粒（PVA）栓塞肿瘤供血动脉。术后4周复查胸腹部CT及监测甲胎蛋白（AFP）值变化，肿瘤若仍无法切除则继续重复TACE治疗直至手术切除。若术前出现肺部转移灶则予全身化疗直至转移灶消失，而后再行TACE治疗直至肿瘤切除。结果Ⅱ期手术组11例共接受TACE治疗24次，TACE后肿瘤体积缩小25．22％～91．24％，平均69．83％（t=3.911，P=0．004）；AFP下降48．69％～99．79％，平均93．78％（t=4．538，P=0．001）。此外，未观察到明显化疗药物毒性反应。除1例因肺转移放弃外科切除外，所有病例均顺利进行手术切除。病理结果显示肿瘤坏死率在57．91％～93．09％，平均77．67％。Ⅰ期手术组手术操作时间为（362．50±44．25）min，Ⅱ期手术组为（281．18±46．72）min，组间比较，差异有统计学意义（t=3．033，P=0．024）；Ⅰ期手术组手术出血量为（50．50±16．42）g／kg，Ⅱ期手术组为（29．40±14．11）g／kg，组间比较，差异有统计学意义（t=2．422，P=0．032）；工期手术组切除肝脏组织重量为（40．25±8．99）g／kg，Ⅱ期手术组为（24．20±5．49）g／kg，组间比较，差异有统计学意义（t=4．144，P=0．001）。工期手术组术后因肺转移或肿瘤复发死亡2例；Ⅱ期手术组1例因术前肺转移放弃治疗，另1例因术后肿瘤复发死亡。术后随访2�
Objective To evaluate the therapeutic efficacies of preoperative transcatheter arterial chemoembolization （TACE） for hepatoblastoma （HB） in infants. Methods The clinical data were retrospectively collected and analyzed for 15 infants with HB treated between July 2007 and July 2010 at our center. Initial diagnosis was made based on computed tomography （CT） scan and then confirmed by the results of pathological biopsy. After a definite diagnosis, surgical resection was performed （group A, n = 4） immediately and followed by TACE （n = 11, group B）. An intraarterial catheter was inserted selectively into main feeding artery of tumor by Seldinger＇s method. During angiography, 60 mg/m^2 cisplatin （CDDP） and 30 mg/m^2 pirarubicin （THP） dispersed in iodized oil contrast medium were injected into liver tumor through hepatic artery followed by polyvinyl alcohol （PVA） pieces soaked in contrast medium until main feeding artery became completely embolized. At week 4 post-TACE,tumor response and surgical resectability were evaluated by CT scan and alpha fetal protein （AFP）. Surgical resection was performed when tumor bulk appeared sufficiently reduced to allow safe resection. Those with pulmonary metastases underwent systemic chemotherapy until the disappearance of metastatic lesions was confirmed with a follow-up CT. TACE was repeated until safe surgical resection. Results TACE was performed successfully in 11 patients. The mean tumor shrinkage rate was 69. 83% （25. 22-91.24%） （t = 3. 911, P = 0. 004）. AFP level showed a mean decrease of 93.78 % （48. 69 %-99. 79 %）（t = 4. 538, P = 0. 001）. Clinical symptoms of drug-related toxicity were not observed during the course of treatment. Pathological examination of specimens showed a mean level of massive necrosis at 77. 67% （57. 91%-93.09%）. The operative duration was （362. 5 ± 44. 25） min in group A versus （281.18 ± 46. 72） min in group B; The intraoperative blood loss was （50. 50 ± 16. 42） g/kg in group A ver
出处
《中华小儿外科杂志》
CSCD
北大核心
2014年第12期923-928,共6页
Chinese Journal of Pediatric Surgery
关键词
癌
肝细胞
化学栓塞
治疗性
治疗结果
Carcinoma, hepatocellular
Chemoembolization, therapeutic
Treatment outcome
