介入治疗在小儿腹部恶性肿瘤的应用

Interventional Therapy for Abdominal Malignant Tumors in Children

目的 对巨大腹部肿瘤采用介入治疗，为肿瘤完整切除创造有利条件。方法 对１２ 例腹部恶性肿瘤患儿进行介入治疗，其中男７ 例，女５ 例。年龄２ 个月～７ 岁。肝母细胞瘤６ 例，神经母细胞瘤３ 例，肾母细胞瘤２ 例，肾上腺皮质癌１ 例。采用Ｓｅｌｄｉｎｇｅｒ○ｓ 技术进行动脉插管造影，确定肿瘤主要供血动脉，进行肿瘤供血动脉超选择性插管，局部注入化疗药物，然后用碘油、明胶海绵或白芨微球栓塞肿瘤的供血动脉。结果 １２ 例中７ 例手术切除了肿瘤，１ 例剖腹探查。余下４ 例通过介入治疗后，肿瘤明显缩小。１２ 例患儿随访追踪，至今存活１０ 例。结论 介入治疗既可经肿瘤供养动脉注入化疗药物，肿瘤局部化疗药物浓度高，减少全身副作用，又可阻断肿瘤供养动脉，使肿瘤缺血坏死，达到治疗目的。同时栓塞后，肿瘤包膜增厚。

Objective The study aims to evaluate the feasibility of preoperative interventional therapy in pediatric abdominal malignant tumors. Methods Twelve children, 7 boys and 5 girls(age range=2?months to 7 years) underwent chemo embolization. There were 6 hepatoblastomas, 3 neuroblastomas, 2 Wilms’ tumors and one malignant adrenal cortex tumor. Major arteries supplying the tumors were determined by arteriogram(Seldinger’s technique). The arteries were selectively cannulated and embolized with cytotoxic chemotherapeutic agents, iodized oil and gelfoam. Results Of them,the tumors of 7 cases were rendered resectable and 4 cases shank in size. One patient underwent explorative laparotomy. Ten cases have survived. Conclusions Interventional therapy via the main tumor arteries enables administration of higher concentration of cytotoxic agents with minimal systemic side effects. It also leads to ischemic tumor necrosis. The thickening of the tumor capsule facilitates the subsequent complete removal.