肝母细胞瘤的综合治疗及影响预后的因素评价  

Combined Therapy on Hepatoblastoma and Evaluation of Relative Factors on Prognosis of It

作　　者：谢勇[1] 龙光辉[1] 刘晓平[1] 周晓初[1] 钟立明[1] 

机构地区：[1]北京大学深圳医院肝胆外科,广东深圳518036

出　　处：《实用儿科临床杂志》2008年第11期833-834,848,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨肝母细胞瘤的综合治疗方法,分析影响肝母细胞瘤治疗效果及生存率的因素。方法对本院2000年1月-2007年11月收治的16例肝母细胞瘤患儿进行回顾性分析和随访,治疗以手术加化疗为主,化疗分为术前化疗和术后化疗,术前化疗11例又分为介入化疗5例和全身化疗6例(其中2例同时进行介入化疗和全身化疗);未进行术前化疗5例。行根治性手术治疗者9例,行姑息性手术治疗者3例,单纯静脉化疗者2例,单纯介入性肝动脉化疗栓塞(TACE)治疗1例,放弃治疗自动出院1例。随访时间13.5(3～98)个月。采用SPSS13.0软件进行统计学分析。结果Ⅳ期高危组患儿总体生存率明显较Ⅰ、Ⅱ、Ⅲ期标准组低;血清甲胎蛋白(AFP)<100μg/L和AFP>100000μg/L患者生存率低;混合型预后较好,而胚胎型及巨梁型预后较差;规范化疗组患者生存率明显高于不规范化疗组;手术组患者生存率明显高于非手术组:有残留组患者预后较无残留组差。结论化疗可提高肝母细胞瘤中晚期患者的总体生存率和长期生存率,TACE是肝母细胞瘤患者一种安全有效的治疗方法;应提高对肝母细胞瘤的认识,及早发现,及时治疗。Objective To explore a more reasonable and effective therapeutic regimen and evaluate prognostic factors in hepatoblastoma patients after combined therapy. Methods Sixteen patients diagnosed on hepatoblastoma between Jan. 2000 and Nov. 2007 were reviewed and followed - up. Resection with chemotherapy was taken among 16 cases. Chemotherapy included pre - operation and post - operation. Five cases were cured by transcatheter arterial chemombolization（ TACE ）. Six cases were cured by single chemotherapy（ both TACE and single chemotherapy were taken in 2 eases ）. Five cases weren＇t cured by pre - operation chemotherapy. Nine cases were subjected to curative resection .3 cases to alleviative resection ,2 cases with single chemotherapy, 1 case with single TACE. and 1 case refused operation and left hospital. Their mean survival duration was 13.5 months （3 - 98 months ）. SPSS 13.0 software was used to analyze the data. Results The total survival rate of cases as stage Ⅳ as lower than cases as stage Ⅰ , Ⅱ and Ⅲ. Both alpha -fetoprotein（AFP） 〈 100 μg/L and AFP 〉 100 000 μg/L cases had worse surival rate. The prognosis of mixed type was better than fetal type, embryonal type and anaplasia type. The survival rate of cases with standard chemotherapy was higher than cases with unstandard chemotherapy. And the surgical resection cases had better survival chance than non - surgical resection cases. The survival rate of surgical residual cases was worse than non - surgical residual cases. Conclusions Chemotherapy can improve the total survival rate and long - term survival rate of hepatoblastoma patients. TACE is a safe and effective choice for hepatoblastoma patients. We need to be alert and make the diagnosis as early as possibe, and treat it early and properly.

关 键 词：肝母细胞瘤 综合治疗 预后 

分 类 号：R735.7[医药卫生—肿瘤]