22例小儿肝脏肿物的治疗体会

Surgical experience of 22 cases with liver tumor in children

目的探讨小儿肿物的临床特征、治疗方法及效果。方法回顾性分析我科在2011年1月~2013年6月收治22例小儿肝脏肿物的临床资料,17例患儿行手术治疗,8例肝母细胞瘤患儿术前进行了介入栓塞治疗,10例患儿手术过程中未阻断肝门,7例患儿手术应用了CUSA和（或）Ligasure能量平台。结果病理证实肝母细胞瘤14例,未分化胚胎性肉瘤1例,局灶性结节性增生3例,婴儿型血管内皮瘤2例,纤维性错构瘤1例,单纯性囊肿1例。肝切除手术应用CUSA和Ligasure的有8例,平均失血量为121 mL;钳夹法肝切除手术9例,平均失血量为248 mL;两组失血量间的差异有统计学意义（P〈0.05）。术中阻断肝门的有7例,平均失血量为170 mL;未阻断肝门的有10例,平均失血量为198.64 mL;两组失血量间的差异无统计学意义。手术7例良性肿瘤术后均无病生存。1例未分化肝胚胎性肉瘤手术后6个月死亡。14例肝母细胞瘤中,9例行手术切除患儿至今仍存活;5例未手术患儿4例死亡,1例存活。结论利用精准肝切除的方法治疗小儿肝脏占位性病变,不论良恶性,都是安全有效的,但对于侵犯肝门或超过3个肝叶以上的肿瘤还需进一步的提高治疗手段。

ObjectiveTo investigate clinical characteristics of liver tumor in children. MethodsA retrospective study was conducted in 22 cases of children with liver tumor between Jan 2011 to Jun 2013. AFP and CT/CTA scan were detected before operation. Twenty two cases were diagnosed by pathological examination...Among them,17 patients underwent surgical operation,..7 cases of them using CUSA and （or） Ligasure energy platform. ResultsCT scan showed 7 tumors in left lobe, 12 tumors in right lobe,..and 3 tumor between right and feft lobe...Pathological exam showed 14 hepatoblastoma,3 focal nodular hyperplasia, 2 infantilism angioendothelioma, 1 fibrous hamartomas,1 embryonic undifferentiated sarcoma,1 simple cyst...Eight cases underwent liver resection with CUSA and Ligasure,..the average of blood loss was 121 mL...9 cases underwent liver resection and the average blood loss was 248 mL. There were statistically significant differences between two groups, P〈0.05. The hepatic porta were blocked in 7 cases and the average blood loss was 170 mL. Non-blocking was in 10 cases,..the average blood loss was 198.64 mL and there was no significant difference between the two groups...Seven cases with benign tumors were disease-free survival after operation. One case with embryonic undifferentiated sarcoma died six months after operation. In the 14 cases with hepatoblastoma, 9 cases underwent liver resection and these patients survived to now. And in 5 cases only received puncture biopsy of liver,4 cases died and 1 case survived. ConclusionUsing precise liver resection to treat pediatric liver lesions, both benign and malignant,it is safe and effective. But in the hilum invaded or more than 3 lobes of the liver tumor,further improving therapeutic measures are necessary.