超声对儿童肝母细胞瘤诊断及PRETEXT分期的应用价值  

Application value of ultrasonography in the diagnosis and PRETEXT staging of hepatoblastoma in children

作　　者：陈晔 刘浩[1] 王训 周昕[1] 朱善良[1] CHEN Ye;LIU Hao;WANG Xun(Department of Ultrasonography,Children's Hospital of Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属儿童医院超声诊断科,南京210008

出　　处：《放射学实践》2022年第9期1160-1165,共6页Radiologic Practice

摘　　要：目的:探讨超声检查对肝母细胞瘤(HB)诊断及治疗前肿瘤分期系统(PRETEXT)分期的应用价值,指导HB的后期治疗并对疗效进行评价。方法:搜集经手术切除后病理证实的HB患儿38例,回顾性分析其超声声像图特征,根据PRETEXT分期标准对HB进行超声PRETEXT分期,计算超声诊断的准确度,比较超声分期与手术分期的一致性。根据PRETEXT分期进行个体化治疗,评价治疗效果。结果:HB超声表现为肝内不均质混杂回声肿块,肿块大小为(102.8±21.1)mm;肿块边界显示不清,内部表现不一,部分肿块内可见钙化灶、小囊状液化坏死区;瘤体内可见肿瘤滋养血管穿行,呈动脉频谱,超声诊断准确度为92%。超声PRETEXT分期为Ⅰ期4例,Ⅱ期18例,Ⅲ期11例,Ⅳ期5例;术中PRETEXT分期为Ⅰ期5例,Ⅱ期22例,Ⅲ期8例,Ⅳ期3例,超声分期与手术分期的一致性较好,kappa值0.671(P<0.05)。根据PRETEXT分期8例直接手术,27例较大肿块化疗后超声复查瘤体缩小后行手术切除,3例瘤体破裂行急诊手术。2例复发,36例随访未发现异常。结论:超声诊断HB准确度较高,对直接手术、分期较早的Ⅰ期、Ⅱ期HB,PRETEXT分期准确度较高,对瘤体较大的Ⅲ期及Ⅳ期HB的分期准确度有待提高,超声可对HB化疗及手术后的治疗效果进行有效评价。Objective:To explore the application value of ultrasonography in the diagnosis and PRETEXT staging of hepatoblastoma(HB)before treatment,to guide the later treatment of HB,and to evaluate the therapeutic effect.Methods:A total of 38 children with HB confirmed pathologically after surgical resection were collected,and their ultrasonographic features were retrospectively analyzed.Ultrasound PRETEXT staging of HB was performed according to PRETEXT staging criteria.The accuracy of ultrasonic diagnosis was calculated,and the consistency between ultrasonography PRETEXT stage and surgical staging was assessed.Personalized treatment was conducted according to the PRETEXT stage,and the therapeutic effect was evaluated.Results:HB manifested as an intrahepatic heterogeneous mass with mixed echo,a size of(102.8±21.1)mm,poorly defined boundary,and variable internal manifestations;calcification foci and small cystic liquefactive necrotic area were found in some masses;Tumor feeding vessels can be seen running through the tumor,presenting an arterial spectrum.The diagnostic accuracy of ultrasound was 92%.Ultrasound PRETEXT staging was 4 cases of stageⅠ,18 cases of stageⅡ,11 cases of stageⅢ,and 5 cases of stageⅣ.Intraoperative PRETEXT staging was 5 cases of stageⅠ,22 cases of stageⅡ,8 cases of stageⅢ,and 3 cases of stageⅣ.There was good consistency between ultrasound and surgical staging,with a kappa value of 0.671(P<0.05).According to the PRETEXT staging,8 patients underwent direct surgery,27 patients of large masses shrank confirmed by ultrasonography after chemotherapy and then underwent surgical resection,and 3 patients underwent emergency surgery for tumor rupture.Two cases recurred,and 36 cases showed no abnormality during follow-up.Conclusions:Ultrasound has high accuracy in diagnosing HB.The accuracy of PRETEXT staging is higher for direct surgery or early stages such as stageⅠandⅡHB,while the staging accuracy for stageⅢandⅣHB with larger tumors needs to be improved.Ultrasonography can effectivel

关 键 词：肝母细胞瘤 超声检查 PRETEXT分期 手术分期 儿童 

分 类 号：R735.7[医药卫生—肿瘤] R445.1[医药卫生—临床医学]