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

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 chemoem－bolization，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。

Abstract:

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 radi－cal resection was observed and therapeutic effect was followed up. Results：One week after the last TACE，63.2%-99.7% （82.9% in av－erage） 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 84.5% 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 pre-operative modality for HB which could hardly be resected radically during stageⅠ. Moreover，fluctuations of AFP and tumor size after TACE could reflect the prognosis of HB indirectly.