婴儿肝母细胞瘤的介入治疗及延迟手术治疗

Transcatheter arterial chemoembolization and delayed surgery for infant hepatoblastoma

目的 评价经动脉栓塞化疗 (TACE)结合延迟手术治疗婴儿巨大肝母细胞瘤的效果。方法 2 0 0 0年 1月～ 2 0 0 4年 1月不能手术切除的肝母细胞瘤 8例患儿 (男 6例 ,女 2例 )接受 1～ 3次栓塞化疗。年龄 2～ 12个月。每次栓塞化疗前均行数字减影血管造影 (DSA)检查 ,栓塞化疗时首先超选择进入肿瘤的供血动脉 ,经该动脉先灌注化疗药物和超液化碘油的混悬乳液 ,再使用弹簧圈栓塞该肿瘤血管。结果 每次TACE均未遇到任何大技术问题和明显化疗毒性反应。 6例TACE结合手术患儿及经 3次TACE及静脉化疗患儿均无瘤存活至今。另 1例 1个月后死于肺炎。结论 TACE是治疗婴儿肝母细胞瘤有效。

Objective To evaluate the effect of transcatheter arterial chemoembolization (TACE) and delayed surgery for infant hepatoblastoma.Methods TACE was performed with the initial digital subtractive angiography (DSA) under general anesthesia 1-3 times in 8 infants with huge hepatoblastoma, whose age was 2 to 12 months. DSA was done via arterials in hepatoblastoma each time before chemoembolization. The arterials were perfused with chemodrugs and suspensions in ultrasome iodized oil , and were blocked with spring rings. DSA findings indicated that the tumor shrank without new tumorous arterials after 1 month in 6 cases, and 4 of them showed no tumorous staining, and the delayed surgery was performed successfully 1 week later in 6 infants. One boy underwent systemic chemotherapy alone during 6 months after 3 times of TACE. Results TACE therapy did not encounter any major technical problem or toxic reaction caused by chemotherapy. The following DSA test 4 weeks later did not detect any new tumorous vessels in 6 cases. Six children received TACE and surgery had been followed-up with no tumor recurrence for months averagely. The boy underwent TACE and venous chemotherapy for 6 months , without surgery , had been followed-up for 48 months until the present report. CT, AFP and DSA did not show any hints of tumor recurrence. Six cases receiving 3 times TACE combined with surgery survived without tumor recurrence. Conclusions TACE is a very effective, safe and helpful therapy for hepatoblastoma, which stressed the repeated use of spring ring to block tumor vessels lastingly if necessary. If surgery is required, DSA test is needed beforehand to detect new tumorous vessels or neoplasm. If there is any , TACE is repeated. TACE combined with surgery may provide an additional promising choice in the treatment of hepatoblastoma, and repeated TACE alone may cure hepatoblastoma in infants.