小儿肝母细胞瘤的诊断和外科治疗

Diagnosis and surgical treatment of hepatoblastoma in childhood

目的总结小儿肝母细胞瘤诊治经验,探讨影响预后因素。方法回顾性分析1992年1月至2005年1月经手术、病理证实的29例肝母细胞瘤的临床资料。结果29例中TNMⅠ期8例、Ⅱ期14例、Ⅲ期6例、Ⅳ期1例;病理学类型有胎儿型18例,胚胎型5例,未分化型3例,混合型3例;行根治性切除25例(86%),姑息性切除4例(14%),并发症发生率13.7%(4/29),术后肝功能10d恢复正常。22例获随访,1、3、4年累积存活率分别为86.4%(n=19)、68.2%(n=15)、36.4%(n=8)。结论手术切除是小儿肝母细胞瘤首选的治疗方法,影响其预后的主要因素是临床分期和肿瘤组织分化程度、病理学类型。

Objective To investigate the diagnosis experience,effects of Surgical treatment and prognosis of hepatoblastoma （HB） in childhood. Methods The clinicopathological and follow-up data in 29 cases treated by hepatectomy from Jan 1992 to Jan 2005 were analyzed retrospectively. Results A retrospective analysis was made on 29 cases of TNM/s stage. There were 8 cases of stage Ⅰ , 14 cases of stage Ⅱ,6 cases of stage Ⅲ and 1 case of stage Ⅳ. 25 （86%） cases underwent radical resection,4 （ 14% ） cases of palliative resection. The overall postoperative complication rate was 13.7% （4/29）. The liver function was recovered within 10 d; Twenty-two patients were followed-up. The overall 1-, 3-, 4-year survival were 19,15 and 8 cases, with survival rate of 86. 4%, 68. 2% and 36.4%. Conclusion Radical resection should be the first recommended treatment for hepatoblastoma in childhood. The clinical stage, differentiation and pathological type of the tumor impact prognosis significantly.