中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2014年
12期
923-928
,共6页
谭小云%张靖%温哲%邹炎%石军%申刚%周少毅%陈昆山%李海波
譚小雲%張靖%溫哲%鄒炎%石軍%申剛%週少毅%陳昆山%李海波
담소운%장정%온철%추염%석군%신강%주소의%진곤산%리해파
癌,肝细胞%化学栓塞,治疗性%治疗结果
癌,肝細胞%化學栓塞,治療性%治療結果
암,간세포%화학전새,치료성%치료결과
Carcinoma,hepatocellular%Chemoembolization,therapeutic%Treatment outcome
目的 探讨经导管动脉化疗栓塞术在婴幼儿肝母细胞瘤手术切除前的疗效.方法 回顾性分析2007年7月至2010年7月间的15例肝母细胞瘤临床资料.所有患儿术前均行CT增强扫描及肝脏肿物穿刺活检以明确诊断.首诊后直接行外科切除术4例(Ⅰ期手术组);首诊后难以手术切除,先予经导管动脉化疗栓塞术(TACE) 11例(Ⅱ期手术组),即将导管插入肿瘤供血动脉,注入吡柔比星(30 mg/m2)+顺铂(60 mg/m2)+超液化碘油形成的乳剂,最后用聚乙烯醇颗粒(PVA)栓塞肿瘤供血动脉.术后4周复查胸腹部CT及监测甲胎蛋白(AFP)值变化,肿瘤若仍无法切除则继续重复TACE治疗直至手术切除.若术前出现肺部转移灶则予全身化疗直至转移灶消失,而后再行TACE治疗直至肿瘤切除.结果 Ⅱ期手术组11例共接受TACE治疗24次,TACE后肿瘤体积缩小25.22％～91.24％,平均69.83％(t=3.911,P=0.004);AFP下降48.69％～99.79％,平均93.78％(t=4.538,P=0.001).此外,未观察到明显化疗药物毒性反应.除1例因肺转移放弃外科切除外,所有病例均顺利进行手术切除.病理结果显示肿瘤坏死率在57.91％～93.09％,平均77.67％.Ⅰ期手术组手术操作时间为(362.50±44.25)min,Ⅱ期手术组为(281.18±46.72)min,组间比较,差异有统计学意义(t=3.033,P=0.024);Ⅰ期手术组手术出血量为(50.50±16.42) g/kg,Ⅱ期手术组为(29.40±14.11)g/kg,组间比较,差异有统计学意义(t=2.422,P=0.032);Ⅰ期手术组切除肝脏组织重量为(40.25±8.99) g/kg,Ⅱ期手术组为(24.20±5.49)g/kg,组间比较,差异有统计学意义(t=4.144,P=0.001).Ⅰ期手术组术后因肺转移或肿瘤复发死亡2例;Ⅱ期手术组1例因术前肺转移放弃治疗,另1例因术后肿瘤复发死亡.术后随访2年,其余11例无瘤存活,未见复发.结论 TACE能显著缩小肿瘤体积,迅速降低AFP值,减少术中出血,有利于手术切除,且无严重化疗药物毒性反应及操作并发症,是手术前治疗婴幼儿肝母细胞瘤,尤其是不能Ⅰ期切除的肝母细胞瘤的有效、安全、实用的方法.
目的 探討經導管動脈化療栓塞術在嬰幼兒肝母細胞瘤手術切除前的療效.方法 迴顧性分析2007年7月至2010年7月間的15例肝母細胞瘤臨床資料.所有患兒術前均行CT增彊掃描及肝髒腫物穿刺活檢以明確診斷.首診後直接行外科切除術4例(Ⅰ期手術組);首診後難以手術切除,先予經導管動脈化療栓塞術(TACE) 11例(Ⅱ期手術組),即將導管插入腫瘤供血動脈,註入吡柔比星(30 mg/m2)+順鉑(60 mg/m2)+超液化碘油形成的乳劑,最後用聚乙烯醇顆粒(PVA)栓塞腫瘤供血動脈.術後4週複查胸腹部CT及鑑測甲胎蛋白(AFP)值變化,腫瘤若仍無法切除則繼續重複TACE治療直至手術切除.若術前齣現肺部轉移竈則予全身化療直至轉移竈消失,而後再行TACE治療直至腫瘤切除.結果 Ⅱ期手術組11例共接受TACE治療24次,TACE後腫瘤體積縮小25.22％～91.24％,平均69.83％(t=3.911,P=0.004);AFP下降48.69％～99.79％,平均93.78％(t=4.538,P=0.001).此外,未觀察到明顯化療藥物毒性反應.除1例因肺轉移放棄外科切除外,所有病例均順利進行手術切除.病理結果顯示腫瘤壞死率在57.91％～93.09％,平均77.67％.Ⅰ期手術組手術操作時間為(362.50±44.25)min,Ⅱ期手術組為(281.18±46.72)min,組間比較,差異有統計學意義(t=3.033,P=0.024);Ⅰ期手術組手術齣血量為(50.50±16.42) g/kg,Ⅱ期手術組為(29.40±14.11)g/kg,組間比較,差異有統計學意義(t=2.422,P=0.032);Ⅰ期手術組切除肝髒組織重量為(40.25±8.99) g/kg,Ⅱ期手術組為(24.20±5.49)g/kg,組間比較,差異有統計學意義(t=4.144,P=0.001).Ⅰ期手術組術後因肺轉移或腫瘤複髮死亡2例;Ⅱ期手術組1例因術前肺轉移放棄治療,另1例因術後腫瘤複髮死亡.術後隨訪2年,其餘11例無瘤存活,未見複髮.結論 TACE能顯著縮小腫瘤體積,迅速降低AFP值,減少術中齣血,有利于手術切除,且無嚴重化療藥物毒性反應及操作併髮癥,是手術前治療嬰幼兒肝母細胞瘤,尤其是不能Ⅰ期切除的肝母細胞瘤的有效、安全、實用的方法.
목적 탐토경도관동맥화료전새술재영유인간모세포류수술절제전적료효.방법 회고성분석2007년7월지2010년7월간적15례간모세포류림상자료.소유환인술전균행CT증강소묘급간장종물천자활검이명학진단.수진후직접행외과절제술4례(Ⅰ기수술조);수진후난이수술절제,선여경도관동맥화료전새술(TACE) 11례(Ⅱ기수술조),즉장도관삽입종류공혈동맥,주입필유비성(30 mg/m2)+순박(60 mg/m2)+초액화전유형성적유제,최후용취을희순과립(PVA)전새종류공혈동맥.술후4주복사흉복부CT급감측갑태단백(AFP)치변화,종류약잉무법절제칙계속중복TACE치료직지수술절제.약술전출현폐부전이조칙여전신화료직지전이조소실,이후재행TACE치료직지종류절제.결과 Ⅱ기수술조11례공접수TACE치료24차,TACE후종류체적축소25.22％～91.24％,평균69.83％(t=3.911,P=0.004);AFP하강48.69％～99.79％,평균93.78％(t=4.538,P=0.001).차외,미관찰도명현화료약물독성반응.제1례인폐전이방기외과절제외,소유병례균순리진행수술절제.병리결과현시종류배사솔재57.91％～93.09％,평균77.67％.Ⅰ기수술조수술조작시간위(362.50±44.25)min,Ⅱ기수술조위(281.18±46.72)min,조간비교,차이유통계학의의(t=3.033,P=0.024);Ⅰ기수술조수술출혈량위(50.50±16.42) g/kg,Ⅱ기수술조위(29.40±14.11)g/kg,조간비교,차이유통계학의의(t=2.422,P=0.032);Ⅰ기수술조절제간장조직중량위(40.25±8.99) g/kg,Ⅱ기수술조위(24.20±5.49)g/kg,조간비교,차이유통계학의의(t=4.144,P=0.001).Ⅰ기수술조술후인폐전이혹종류복발사망2례;Ⅱ기수술조1례인술전폐전이방기치료,령1례인술후종류복발사망.술후수방2년,기여11례무류존활,미견복발.결론 TACE능현저축소종류체적,신속강저AFP치,감소술중출혈,유리우수술절제,차무엄중화료약물독성반응급조작병발증,시수술전치료영유인간모세포류,우기시불능Ⅰ기절제적간모세포류적유효、안전、실용적방법.
Objective To evaluate the therapeutic efficacies of preoperative transcatheter arterial chemoembolization (TACE) for hepatoblastoma (HB) in infants.Methods The clinical data were retrospectively collected and analyzed for 15 infants with HB treated between July 2007 and July 2010 at our center.Initial diagnosis was made based on computed tomography (CT) scan and then confirmed by the results of pathological biopsy.After a definite diagnosis,surgical resection was performed (group A,n =4) immediately and followed by TACE (n =11,group B).An intraarterial catheter was inserted selectively into main feeding artery of tumor by Seldinger's method.During angiography,60 mg/m2 cisplatin (CDDP) and 30 mg/m2 pirarubicin (THP) dispersed in iodized oil contrast medium were injected into liver tumor through hepatic artery followed by polyvinyl alcohol (PVA) pieces soaked in contrast medium until main feeding artery became completely embolized.At week 4 postTACE,tumor response and surgical resectability were evaluated by CT scan and alpha fetal protein (AFP).Surgical resection was performed when tumor bulk appeared sufficiently reduced to allow safe resection.Those with pulmonary metastases underwent systemic chemotherapy until the disappearance of metastatic lesions was confirmed with a follow-up CT.TACE was repeated until safe surgical resection.Results TACE was performed successfully in 11 patients.The mean tumor shrinkage rate was 69.83％ (25.22％-91.24％) (t =3.911,P =0.004).AFP level showed a mean decrease of 93.78％ (48.69％-99.79％)(t =4.538,P =0.001).Clinical symptoms of drug-related toxicity were not observed during the course of treatment.Pathological examination of specimens showed a mean level of massive necrosis at 77.67％ (57.91 ％-93.09％).The operative duration was (362.5 ± 44.25)min in group A versus (281.18 ± 46.72) min in group B; The intraoperative blood loss was (50.50 ± 16.42) g/kg in group A versus (29.40 ± 14.11) g/kg in group B; The weight of resected liver was (40.25 ± 8.99) g/kg in group A versus (24.20 ± 5.49) g/kg in group B.Comparison of characteristics of groups A and B revealed that TACE significantly reduced operative duration (t =3.033,P =0.024),rate of intraoperative hemorrhage (t =2.422,P =0.032) and weight of resected liver tissue (t =4.144,P =0.001).Two patients died postoperatively from pulmonary metastasis or tumor recurrence in Group A.Solitary pulmonary metastasis was found in one infant during TACE and another with poorly differentiated hepatoblastoma died postoperatively of tumor progression at month 5 in group B.Eleven of them survived without evidence of disease for 2 years after operation.Conclusions TACE is effective in shrinking tumor volume,decreasing AFP and reducing hemorrhage during operation.And it is safe,useful and efficacious for unresectable infantile hepatoblastoma without serious toxicities or complications.
