介入放射学在肝母细胞瘤诊治中的作用评价

Treatment of hepatoblastoma with transcatheter arterial chemoembolization

目的评价数字减影血管造影(digital substractive angiography,DSA)检查肝母细胞瘤(hepatoblastoma,HB)的价值,以及经动脉栓塞化疗(transcatheter arterial chemoembolization,TACE)在治疗HB中的作用。方法 2000年1月至2011年6月对收治的14例HB患儿(年龄2～12月)进行1～3次栓塞化疗,1月后所有患儿再次入院并接受DSA检查。回顾性分析总结14例患儿的临床资料。结果本组14例患儿全部获得随访,13例患儿于介入治疗4周后入院,检查显示肿瘤明显缩小,甲胎蛋白(AFP)明显降低。第二次DSA检查7例未发现新生的肿瘤血管,6例有新生肿瘤血管形成。1例患儿经3次TACE后肿瘤影全部消失,未予手术治疗,追加了6月的静脉化疗。12例TACE结合手术的患儿,术后病理显示肿瘤细胞75%～100%坏死。13例患儿获得随访并存活至今,1例患儿于TACE后1月因患肺炎伴心力衰竭死亡。结论 DSA是针对肿瘤具有高度分辨率的影像学检查手段,不但能精确显示肿瘤血管,还可以准确显示肿瘤的形态、边界。TACE是一个有效、安全的HB治疗方法。在手术切除前有必要进行DSA检查以了解有否新生的肿瘤血管及新发的肿瘤。对于新生的肿瘤血管应给予再次的TACE治疗。应用介入放射学技术结合延迟手术及随后的静脉辅助化疗可显著提高难治性HB的近期效果,并可能完全治愈HB。仅仅通过反复TACE亦有可能治愈HB。

Objective Hepatoblastoma （HB） frequently presents at an advanced and unresectable stage. Methods Transcatheter arterial chemoembolization （TACE） had been attempted to improve the feasibility of removing the bulky tumor in the authors＇ hospital and the results were presented here to evaluate the effectiveness and therapeutic role of TACE in the HB infants. Fourteen patients （ 11 boys, 3 girls）, ranging in age from 2 months to 12 months, had unresectable HB based on clinical manifestation, B-ultrasound （ B-US）, chest X-ray film, computed tomography （ CT）, blood chemistry, and serum a-fetoprotein （ AFP）, and were subjected to TACE 1-3 times. On each TACE, Adriamycin （ ADR, 20 mg/m2 ）, vincristine （ VCR, 1.5 mg/m2 ）, and cisplatin （ CDDP, 40 mg/m2） dispersed in 5-10 mL lipiodol were infused into the tumor, and stainless-steel embolization coils were released into the main feeding artery until completely embolized. Then,all the patients were reexamined once a month. Results Digital subtractive angiography was performed and the therapeutic strategy of further TACE or surgery was individualized in terms of the changes of tumor stain and the newly forming feeding artery. 7 children （50%） had a marked response after the first TACE and were judged as being surgically resectable,but one boy died of pneumonia just before the scheduled operation and another boy preferred further TACE. The other 7 patients had only a partial response and required further TACE before the operation. Thus 12 chil- dren eventually underwent complete surgical resection and 1 boy achieved successful disappearance of tumor after 3 episodes of TACE alone. Thirteen children had an excellent recovery and remained tumor-free for 30-120 months（ means 70 months）. Conclusion The results indicate that TACE is an effective and useful preoperative therapeutic choice for unresectable hepatoblastoma, and can improve the resectablity of the bulky tumor and the survival rate of HB patients. Multiple TACE could enhance the therapeutic effect and should be considered if indicated.