中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2015年
1期
26-31
,共6页
肝肿瘤%消融技术%药物疗法,联合
肝腫瘤%消融技術%藥物療法,聯閤
간종류%소융기술%약물요법,연합
Liver neoplasms%Ablation techniques%Drug therapy,combination
目的 评估儿童Ⅲ、Ⅳ期肝母细胞瘤化疗联合HIFU消融和化疗之间的疗效有无差异.方法 回顾性分析2007年8月至2013年6月重庆医科大学附属儿童医院收治的30例Ⅲ、Ⅳ期肝母细胞瘤的临床资料.重新评价化疗联合HIFU消融(n=12)或化疗(n=18)后肿瘤可切除性.随访肿瘤大小,生存状况,转移及复发,甲胎蛋白等.结果 化疗联合HIFU消融较化疗可以显著提高缓解率(P=0.002,确切概率法)和手术可切除率(P=0.024,确切概率法).粒细胞减少(P=0.13)、心脏毒性和肾毒性(P=0.36)等副作用在化疗联合HIFU消融组与化疗组无差异.肿瘤反应及预后(P=0.001,确切概率法)和疾病进展(P=0.018,确切概率法)有显著统计学差异,未手术的化 疗组患儿死亡率较化疗联合HIFU消融组高(P=0.001,确切概率法);疾病复发与死亡在两种治疗方式中无明显统计学差异.化疗联合HIFU消融组治疗前后的甲胎蛋白(＞363 000 μg/L,0.27μg/L)及肿瘤直径(112mm,27m m);化疗组治疗前后的甲胎蛋白(＞363 000 μg/L,219 000 μg/L)及肿瘤直径(119mm,84m m).化疗联合HIFU消融组的生存时间16～62个月,中位生存时间45个月,1年生存率100％,3年生存率83.3％,5年生存率16.7％,病死率16.7％;化疗组的中位生存时间18个月,1年生存率83.3％,3年生存5.6％,病死率55.5％.化疗联合HIFU消融可以显著提高生存率,延长生存时间.结论 化疗联合HIFU治疗儿童不可切除的肝母细胞瘤显著提高缓解率和手术可切除率,延长生存期,是不可切除肿瘤患儿的较好选择.
目的 評估兒童Ⅲ、Ⅳ期肝母細胞瘤化療聯閤HIFU消融和化療之間的療效有無差異.方法 迴顧性分析2007年8月至2013年6月重慶醫科大學附屬兒童醫院收治的30例Ⅲ、Ⅳ期肝母細胞瘤的臨床資料.重新評價化療聯閤HIFU消融(n=12)或化療(n=18)後腫瘤可切除性.隨訪腫瘤大小,生存狀況,轉移及複髮,甲胎蛋白等.結果 化療聯閤HIFU消融較化療可以顯著提高緩解率(P=0.002,確切概率法)和手術可切除率(P=0.024,確切概率法).粒細胞減少(P=0.13)、心髒毒性和腎毒性(P=0.36)等副作用在化療聯閤HIFU消融組與化療組無差異.腫瘤反應及預後(P=0.001,確切概率法)和疾病進展(P=0.018,確切概率法)有顯著統計學差異,未手術的化 療組患兒死亡率較化療聯閤HIFU消融組高(P=0.001,確切概率法);疾病複髮與死亡在兩種治療方式中無明顯統計學差異.化療聯閤HIFU消融組治療前後的甲胎蛋白(＞363 000 μg/L,0.27μg/L)及腫瘤直徑(112mm,27m m);化療組治療前後的甲胎蛋白(＞363 000 μg/L,219 000 μg/L)及腫瘤直徑(119mm,84m m).化療聯閤HIFU消融組的生存時間16～62箇月,中位生存時間45箇月,1年生存率100％,3年生存率83.3％,5年生存率16.7％,病死率16.7％;化療組的中位生存時間18箇月,1年生存率83.3％,3年生存5.6％,病死率55.5％.化療聯閤HIFU消融可以顯著提高生存率,延長生存時間.結論 化療聯閤HIFU治療兒童不可切除的肝母細胞瘤顯著提高緩解率和手術可切除率,延長生存期,是不可切除腫瘤患兒的較好選擇.
목적 평고인동Ⅲ、Ⅳ기간모세포류화료연합HIFU소융화화료지간적료효유무차이.방법 회고성분석2007년8월지2013년6월중경의과대학부속인동의원수치적30례Ⅲ、Ⅳ기간모세포류적림상자료.중신평개화료연합HIFU소융(n=12)혹화료(n=18)후종류가절제성.수방종류대소,생존상황,전이급복발,갑태단백등.결과 화료연합HIFU소융교화료가이현저제고완해솔(P=0.002,학절개솔법)화수술가절제솔(P=0.024,학절개솔법).립세포감소(P=0.13)、심장독성화신독성(P=0.36)등부작용재화료연합HIFU소융조여화료조무차이.종류반응급예후(P=0.001,학절개솔법)화질병진전(P=0.018,학절개솔법)유현저통계학차이,미수술적화 료조환인사망솔교화료연합HIFU소융조고(P=0.001,학절개솔법);질병복발여사망재량충치료방식중무명현통계학차이.화료연합HIFU소융조치료전후적갑태단백(＞363 000 μg/L,0.27μg/L)급종류직경(112mm,27m m);화료조치료전후적갑태단백(＞363 000 μg/L,219 000 μg/L)급종류직경(119mm,84m m).화료연합HIFU소융조적생존시간16～62개월,중위생존시간45개월,1년생존솔100％,3년생존솔83.3％,5년생존솔16.7％,병사솔16.7％;화료조적중위생존시간18개월,1년생존솔83.3％,3년생존5.6％,병사솔55.5％.화료연합HIFU소융가이현저제고생존솔,연장생존시간.결론 화료연합HIFU치료인동불가절제적간모세포류현저제고완해솔화수술가절제솔,연장생존기,시불가절제종류환인적교호선택.
Objective To compare the treatment outcomes of chemotherapy plus high-intensity focused ultrasound (HIFU) ablation versus chemotherapy alone in children with stages Ⅲ and Ⅳ hepatoblastoma.Methods Retrospective analyses were conducted for the clinical data of 30 cases of stages Ⅲ and Ⅳ hepatoblastoma from August 2007 to June 2013.Re-evaluation of tumor resecfability after treatment was made for chemotherapy plus HIFU ablation (n =12) versus chemotherapy (n =18).And follow-ups were conducted for tumor size,survival,metastasis,recurrence and alphafetoprotein.Results As compared with chemotherapy,chemotherapy plus HIFU ablation could significantly improve the response rate (P =0.002,Fishers exact test) and surgical resection rate (P =0.024,Fisher＇s exact test).Neutropenia (P=0.13),cardiac & renal toxicity (P =0.36) and other side effects showed no inter-group difference.Tumor response and prognosis (P =0.001,Fisher＇s exact test) and disease progression (P =0.018,Fisher＇s exact test) had significant differences.A higher mortality rate was found in chemotherapy patients without surgery than chemotherapy plus HIFU group (P =0.001,Fisher＇s exact test).Recurrence or death showed no significant inter-group difference.In chemotherapy plus HIFU ablation group,AFP before and after treatment.was (＞ 363,000 μg/L,0.27 μg/L) and diameter of tumor (112 mm,27 mm).In chemotherapy group,AFP (＞363,000μg/L,219,000 μg/L),tumor diameter (119 mm,84 mm).For chemotherapy plus HIFU ablation group,median survival time was 45 (16-62) months,1-year survival rate 100％,3-year survival rate 83.3％,5-year survival rate 16.7％ and mortality rate 16.7％ ; For chemotherapy group,median survival time was 18 months,1-year survival rate 83.3％,3-year survival 5.6％ and mortality rate 55.5％.Chemotherapy plus HIFU ablation could significantly improve survival rate and prolong survival time.Conclusions Chemotherapy plus HIFU treatment may significantly improve remission rate,boost surgical resectability rate and prolong survival for children with unresectable tumor.
