经导管动脉栓塞术治疗肝母细胞瘤破裂的初步探索  

Preliminary exploration of transcatheter arterial embolization for ruptured hepatoblastoma

作　　者：林宇 王焕民[1] 杨深 秦红[1] 杨维[1] 成海燕[1] 常晓峰[1] 冯俊 韩建宇 常赛朔 阴捷[2] Lin Yu;Wang Huanmin;Yang Shen;Qin Hong;Yang Wei;Cheng Haiyan;Chang Xiaofeng;Feng Jun;Han Jianyu;Chang Saishuo;Yin Jie(Department of Oncology Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China;Medical Imaging Center,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院肿瘤外科,北京100045 [2]国家儿童医学中心,首都医科大学附属北京儿童医院影像中心,北京100045

出　　处：《临床小儿外科杂志》2023年第12期1109-1113,共5页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金重大项目(82293665)

摘　　要：目的探讨经导管动脉栓塞术(transcatheter arterial embolization,TAE)在肝母细胞瘤(hepatoblastoma,HB)破裂中的治疗价值。方法回顾性收集2021年3月至2023年5月首都医科大学附属北京儿童医院收治的10例接受TAE治疗的HB破裂患儿临床资料,总结分析患儿临床特点、实验室及影像学检查特点与预后。结果本研究共纳入10例患儿,其中男1例,女9例。发病月龄为21.5(13.3,45.3)个月,初诊时肿瘤长径13.0(10.8,15.3)cm,甲胎蛋白(alpha fetoprotein,AFP)均明显升高[443641(137598,877500)ng/mL]。肿瘤破裂后血红蛋白和红细胞计数均下降,低谷血红蛋白69.0(56.3,85.8)g/L。根据PRETEXT术前分期系统,Ⅱ期1例、Ⅲ期7例、Ⅳ期2例。患儿均接受TAE治疗,其中9例成功止血。随访时间15.00(3.75,19.25)个月。9例生存,1例死亡。结论HB破裂临床罕见,治疗难度大,患儿常伴有肿瘤负荷大、一般情况差、血色素进行性下降等。TAE是其有效治疗方式。对于预期药物止血效果欠佳的患儿,建议尽早行介入治疗以达到止血目的。Objective To explore the application of transcatheter arterial embolization(TAE)for ruptured hepatoblastoma(HB).Methods From March 2021 to May 2023,clinical characteristics,laboratory examinations,imaging features and outcomes were retrospectively reviewed for 10 children with ruptured HB undergoing TAE.Results There were 1 boy and 9 girls with a median onset age of 21.5(13.3,45.3)months.The median tumor diameter at diagnosis was 13.0(10.8,15.3)cm.Alpha fetoprotein(AFP)was elevated at an initial diagnosis.And the median value of AFP was 443641(137598,877500)ng/ml.After rupture,hemoglobin and erythrocyte declined and the median trough value of hemoglobin was 69.0(56.3,85.8)g/L.According to the PRETEXT preoperative staging system,the stagesⅡ(n=1),Ⅲ(n=7)andⅣ(n=2).The frequency of TAE was once(n=7)and twice(n=3).After TAE,9/10 cases achieved successful hemostasis.During a median follow-up period of 15.00(3.75,19.25)month,9 patients survived and 1 died.Conclusions HB rupture is quite rare and difficult to treat.There are a heavy tumor burden,poor general status and a progressive decline of hemoglobin.For children responding poorly to hemostatic agents,interventional therapy is recommended.

关 键 词：肝母细胞瘤 破裂 血管内操作 栓塞 治疗性 手术后并发症 治疗 预后 儿童 

分 类 号：R735.7[医药卫生—肿瘤]