术前应用经导管动脉化疗栓塞治疗儿童肝母细胞瘤的疗效分析  

Therapeutic efficacy of transcatheter arterial chemoembolization in the treatment of pediatric hepatoblastoma before resection

作　　者：吴艳梅[1] 王珊[1] 胡显良[2] 张利兵[2] 张英姿[2] 陈联盟 谭培兰 

机构地区：[1]重庆医科大学附属儿童医院肿瘤外科,重庆400014 [2]重庆医科大学附属成都市妇女儿童中心医院儿外科.成都610091 [3]成都市363医院放射科,成都610041

出　　处：《重庆医科大学学报》2014年第2期241-245,共5页Journal of Chongqing Medical University

摘　　要：目的：分析肝母细胞瘤（hepatoblastoma,HB）的临床特点,探讨经导管动脉化疗栓塞（transcathere arterial chemoembolization,TACE）在HB中的治疗价值。方法：回顾性分析我院2005年8月至2012年1月收治的5例HB患儿病历资料,根治性手术前均进行2~3次TACE治疗,比较治疗前后甲胎蛋白（alpha fetal protein,AFP）及肿瘤大小变化情况,观察其根治性手术成功率及随访临床疗效。结果：经2~3次TACE治疗后1周复查,4例患儿血清AFP下降63.2%~99.7%,平均82.9%,肿瘤缩小28.7%-76.3%,平均61.4%;1例患儿AFP升高69.8%,肿瘤增大84.5%。4例完成根治性手术,随访6~87月（平均35.6月）,无瘤存活至今。1例手术前CT检查发现远处转移,放弃治疗后1月死亡。结论：对于Ⅰ期根治性切除困难的HB,采取术前TACE治疗,不良反应轻,使大部分患儿获得根治性手术切除,术后无瘤生存率高,可将其作为Ⅰ期根治性切除困难的HB术前治疗主要手段。TACE术后AFP及肿瘤大小变化可间接反映HB的远期预后。Objective ：To analyze the clinical characteristics of hepatoblastoma（HB） and to explore the therapeutic efficacy of tran- scathtr arterial chemoembolization（TACE） in the treatment of HB. Methods：Clinical records of 5 hospitalized children diagnosed with HB from August 2005 to January 2012 were analyzed respectively. The 5 patients underwent 2-3 times TACE therapy before radical resection. Levels of alpha fetal protein（AFP） and tumor size between pre-TACE and post-TACE were compared. Success rate of radical resection was observed and therapeutic effect was followed up. Results：One week after the last TACE,63.2%-99.7% （82.9% in average） decrease of AFP and 28.7%-76.3%（61.4% in average） shrinkage of tumor size were observed in four cases;69.8% increase of AFP and $4.5% increase of tumor size were observed in one case. Four patients completed the radical resection and were followed up for 6-87 months（35.6 in average） without any tumor till now. However,distant metastasis of 1 case was displayed by CT before resection and the subsequent treatment was given up;the patients＇ life was ended one month later. Conclusions：With the advantages of slighter adverse reaction, more successful radical resection and higher event free survival rate, TACE can be used as a primary preoperative modality for HB which could hardly be resected radically during stage I. Moreover, fluctuations of AFP and tumor size after TACE could reflect the prognosis of HB indirectly.

关 键 词：肝母细胞瘤 经导管动脉化疗栓塞 根治性手术 甲胎蛋白 肿瘤大小 

分 类 号：R739.9[医药卫生—肿瘤]