儿童肝脏恶性肿瘤的肝移植适应证

Indications for liver transplantation in children with hepatic malignancies

儿童肝脏恶性瘤与成人肝脏恶性肿瘤的起源和发展存在明显差别,即使是同一种肝脏恶性肿瘤,在儿童体内的发生、发展、治疗方法和治疗效果方面,也与成人存在较大的差别。肝脏恶性肿瘤的组织学表现和解剖定位可以反映出这些肿瘤侵袭转移的特性、外科手术根治的难度和药物治疗的敏感性。因此在治疗方式选择上,需要依据这些特点进行判断。儿童的肝脏恶性肿瘤对化疗等辅助治疗的敏感性更高。肝移植术前或术后,配合使用化疗等辅助治疗可以获得更为满意的疗效,肝移植的适应证范围也因此得到了一定的扩展。儿童肝脏恶性肿瘤中,肝母细胞瘤、肝细胞癌和未分化胚胎肉瘤较为常见,均可以通过肝移植进行治疗,且多数患者预后满意。儿童肝脏恶性肿瘤如果肝切除治疗预期效果不佳,而肿瘤局限于肝内,均可考虑肝移植。

There are significant differences in origin and development between pediatric liver malignancies and adult liver malignancies,and even for the same type of liver cancer,there are still differences in its development,progression,therapies,and treatment outcome between children and adults.The histological manifestation and anatomical location of pediatric liver malignancies can reflect the characteristics of invasion and metastasis,the difficulty in surgical treatment,and the sensitivity of drug therapy.Therefore,treatment modalities should be selected based on these characteristics.Pediatric liver malignancies are more sensitive to adjuvant therapy such as chemotherapy,and the combination with adjuvant therapies,such as chemotherapy,before or after liver transplantation may achieve satisfactory results and thus expand the indications for liver transplantation.Among pediatric liver malignancies,hepatoblastoma,hepatocellular carcinoma,and undifferentiated embryonal sarcoma is more common and can be treated by liver transplantation with satisfactory prognosis.Liver transplantation should be considered for children with malignant liver tumors confined to the liver and poor response to liver resection.