经导管动脉化疗栓塞联合手术治疗儿童肝母细胞瘤

Combined transcatheter arterial chemoembolization and surgery in treating hepatoblastoma

目的探讨对不能切除的小儿肝母细胞瘤实行动脉化疗栓塞术（TACE）治疗的临床可行性、疗效及作用。方法8例常规不能切除的肝母细胞瘤经TACE治疗20次，再行Ⅱ期外科手术切除，比较分析治疗前后临床症状、体征和血AFP的变化、术中情况及随访远期疗效。结果TACE术后4～6周复查，和术前相比，肿瘤体积缩小67．68％～95．91％，平均缩小87．91％（t=3．754，P=0．007），血AFP下降94．46％～99．97％，平均98．45％（t=2．931，P=0．022），无明显的化疗毒性反应，所有患儿手术完整切除肿瘤，术后病理显示肿瘤明显坏死。随访8～24个月，所有患儿均获无瘤生存。结论TACE治疗肝母细胞瘤安全有效，无严重并发症，能使部分不能Ⅰ期手术的患儿重新获得手术机会，并对减少术中肿瘤细胞的扩散和术中出血、改善预后有较大作用，可作为无远处转移肝母细胞瘤的术前辅助治疗。

Objective To evaluate the feasibility, efficacy of transcatheter arterial chemoembolization （TACE） for unresectable hepatoblastoma in children. Methods Eight patients with unresectable hepatoblastoma underwent 20 TACE before the secondary surgical resections. The changes of clinical symptoms, signs and AFP before and after TACE were analyzed. The long term therapeutic effect was assessed. Results Re-examinations were performed in 4 to 6 weeks after TACE. The tumors treated with TACE decreased in size by 87. 91% （67. 68-95. 91%） （Paired samples T test, t = 3. 754, P = 0. 007）, and the levels of AFP dropped by 98. 45 % （94. 46-99. 97 % ） （Paired samples T- test, t = 2. 931, P = 0. 022）. No significant chemotherapeutic toxicity was observed. All eight hepatoblastomas were safely excised after the chemotherapy. Pathological examination showed massive necrosis in the resected tumor tissues. During the 8-24 months follow-up period, tumor-free survival was observed in all eight patients. Conclusions TACE is a safe, effective therapeutic method for unresectable hepatoblastoma in children. It is also effective in reducing hemorrhage during operation. It is an effective adjuvant therapy for hepatoblastoma with no metastasis.