中晚期肾母细胞瘤术前介入治疗的临床研究

Preoperative interventional therapy for children with advanced Wilms' tumor

目的 探讨介入性肾动脉栓塞化疗 (transcatheterarterialchemo embolization ,TACE)作为一种术前化疗方法治疗巨大或晚期肾母细胞瘤的可行性。方法 10例巨大或晚期肾母细胞瘤术前行TACE ,栓塞剂为 40 %碘油 (或超液化碘油 ) 0 .5～ 0 .6ml/kg、阿霉素 10～ 15mg/m2 (体表面积 )和明胶海绵 ,2周后手术切除瘤肾。结果 TACE后有发热 ,但无骨髓抑制、肝肾功能和心电图改变 ,肿瘤缩小 ,手术时出血较少 ,易完整切除。治疗后有“降期”现象 ,有 5例因肿瘤彻底坏死而术后不能确定组织类型。结论 TACE的优点是化疗药物剂量小 ,全身副作用少 ,肿瘤坏死较彻底 ,可将术前治疗时间缩短为 2周 ,可作为一种术前化疗方法 ,单独应用或与全身用药并用于中晚期肾母细胞瘤的治疗。缺点与静脉用药术前化疗相似 ,有“降期”现象 ,且因肿瘤彻底坏死而组织分型困难。

Objective To study the effects of preoperative interventional therapy on children with large or advanced Wilms' tumor.Methods Ten patients with large or advanced Wilms' tumor were performed on preoperative interventional chemoembolization with adriamycin, iodized oil and gelatin sponge, and underwent operation two weeks later.Results The patients had fever, but no bone marrow depression or hepatic, renal and cardiac dysfunction after interventional therapy. The size of tumor was shrinkage. It was less bleeding and easier to achieve a complete resection. 'Downstaging' and necrosis of the tumor were found in some cases.Conclusions The advantages of preoperational interventional therapy are lower dosage of chemotherapy, less side effects and obvious tumor necrosis. It could be applied as preoperative therapy or adjuvant chemotherapy making surgical resection possible. Because of the 'Downstaging' expression, it is difficult in a histodiagnosis in some cases. Percutaneous fine needle biopsy may be helpful to a definite histology.