儿童肝母细胞瘤精准肝切除手术效果评价  

Evaluations of precise hepatectomy for pediatric hepatoblastoma

作　　者：杨维[1] 任清华 秦红[1] 常赛硕 王焕民[1] Yang Wei;Ren Qinghua;Qin Hong;Chang Saishuo;Wang Huanmin(Department of Surgical Oncology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院肿瘤外科,北京市100045

出　　处：《临床小儿外科杂志》2020年第5期392-397,共6页Journal of Clinical Pediatric Surgery

基　　金：中国工程院咨询研究课题(编号:2019-XY-34)。

摘　　要：目的对儿童肝母细胞瘤精准肝切除的手术效果进行评价,探讨肝母细胞瘤手术治疗方式。方法选取自2014年6月至2019年5月于首都医科大学附属北京儿童医院进行精准肝切除治疗的肝母细胞瘤患儿作为研究对象(为精准肝切除组)。回顾性收集患儿肿瘤分期、危险度分级、肿瘤生长部位、肿瘤体积大小、术前化疗情况、手术时间、术中失血量、术后血清谷丙转氨酶(alanine aminotransferase,ALT)水平、谷草转氨酶(aspartate aminotransferase,AST)水平、术后并发症、腹腔引流管留置时间、术后住院时间、远期生存状况等指标,并与同期收治的行标准肝叶切除手术的肝母细胞瘤患儿(为标准肝叶切除组)进行对比,对其手术疗效进行评估。结果本次研究共纳入134例患儿,其中88例行精准肝切除术(65.7%),46例行标准肝叶切除术(34.3%)。对比采用不同手术方式进行肿瘤切除手术的患儿,发现精准肝切除组术中失血量、ALT及AST水平低于标准肝叶切除组,术后引流管留置天数少于标准肝叶切除组。远期预后方面,两组2年无事件生存(events free survival,EFS)率和2年总体生存(overall survival,OS)率差异无统计学意义(P>0.05);应用PRETEXT分期(pretreatment extension stage)进行分层后发现,精准肝切除组中PRETEXTⅢ期患儿的2年OS率高于标准肝叶切除组。结论对于儿童肝母细胞瘤患者,在进行个体化评估后,采用精准肝切除手术可以达到完整去除肿瘤病灶、减轻手术打击、减少术后并发症的目的,预后良好。Objective To evaluate the outcomes of precision hepatectomy for pediatric hepatoblastoma(HB)and explore its choice of surgical approaches.Methods From June 2014 to May 2019,a total of 134 HB children undergoing precision hepatectomy were selected.Tumor stage,risk grade,tumor growth site,tumor size,preoperative chemotherapy,operative duration,intraoperative blood loss,postoperative serum levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were collected retrospectively.And the relevant parameters of postoperative complications,duration of abdominal drainage tube,postoperative hospital stay and long-term survival status were compared with those of HB counterparts undergoing standard hepatectomy in the same period and the therapeutic outcomes were evaluated.Results The procedures were precision hepatectomy(n=88,65.7%)and standard hepatectomy(n=46,34.3%).Based upon different resection approaches,they were divided into precision and standard hepatectomy groups.Intraoperative blood loss,postoperative levels of ALT&AST and postoperative duration of drainage tube were lower in precision hepatectomy group than those in regular hepatectomy group.In terms of long-term prognosis,no significant inter-group difference existed in 2-year events-free survival(EFS)or 2-year overall survival(OS).After stratified correction with RETEXT stage(pretreatment extension stage),2-year OS of patients with PRETEXTⅢstage in precision hepatectomy group was higher than that in regular hepatectomy group.Conclusion For HB children,accurate hepatectomy after individualized evaluations can completely remove tumor foci,reduce operative insults and minimize the occurrence rate of postoperative complications for an optimal prognosis.

关 键 词：肝肿瘤 外科手术 手术后并发症 治疗 预后 

分 类 号：R735.7[医药卫生—肿瘤] R726.1[医药卫生—临床医学]