经导管动脉化疗栓塞在肝母细胞瘤综合治疗中的应用评价及文献回顾

目的：探讨经导管动脉化疗栓塞术（TACE ）在肝母细胞瘤综合治疗中的作用及疗效。方法回顾性总结2005年-2013年收治的10例经TACE 治疗的肝母细胞瘤患儿的临床资料。随访治疗后患儿的全身情况、血AFP值及瘤体体积大小的变化及生存情况。结果患儿10例，男女比例4∶1，发病中位年龄9.5个月（1个月～10岁），10例患儿首诊后均予以1～4次TACE 治疗，其中6例TACE＋手术＋化疗，1例TACE＋化疗，3例在TACE 治疗后放弃继续治疗。介入治疗后肿瘤体积较前均有明显缩减（26.2％～10.00％，平均70.0％），血清AFP值下降明显（28.5％～99.7％，平均83.6％）。所有患儿在接受TACE 治疗后均出现不同程度的发热、呕吐、一过性肝功能损害（Ⅰ度3例，Ⅱ度2例，Ⅲ度1例）、轻度骨髓抑制、贫血等不适，未见明显心脏毒性及肾毒性损害。随访时间2～114个月，平均随访时间为36.1个月，1年存活率100％（7／7），2年存活率86％（6／7），3年存活率71％（5／7）。6例患儿在接受TACE治疗后成功行手术切除，术后均接受全身化疗，1例仅经过4次TACE治疗及化疗后肿瘤消失，未行手术治疗，均无瘤存活至今。3例放弃治疗患儿分别于2～8个月后死亡。结论 TACE治疗可作为肝母细胞瘤术前重要的辅助治疗方式，能够使肿瘤体积明显缩小，血供减少，促进肿瘤包膜增厚，为尽可能完整切除创造了条件，能够改善肝母细胞瘤患儿的生活质量，提高长期存活率。

Appraisal of transcatheter arterial chemoebolization in comprehensive treament of hepatoblastoma and literature review

Objective To investigate the therapeutic effect of transcatheter arterial chemoebolization （TACE） in the comprehensive therapy of hepatoblastoma （HB）. Methods Clinical data of 10 hospitalized children diagnosed with HB from 2005 to 2013 were summarized retrospectively. Follow-up the patientg systemic condition, serum AFP value volume changes of the tumors before and after TACE therapy. Results In the 10 cases summarized,the Male to female ratio was 4 ： 1, and the medium age was 9.5 months old（ 1 month - 10 years old）. The 10 cases of children underwent 1-4 times of TACE therapy after the preliminary diagnosis, 6 patients underwent TACE therapy followed by surgical resection in combination with chemotherapy, 1 case received only TACE therapy and chemotherapy, and 3 patients didn＇ t receive surgical resection after TACE treatment, as their family members gave up the treatment.All of the patients after TACE therapy occurred different degrees of fever, vomiting, transient liver function damage （ I degree 3 cases; II degree 2 cases, III degree 1 case）, mild bone marrow suppression, and anemia, but we didn＇ t find obvious cardiac toxicity and kidney toxicity. After the TACE, shrinkage （26.2% - 100.0% , average 70.0% ） of tumor size and decrease （28.5% -99.7% , average 83.6% ） of AFP value were observed. All patients were followed up for 2 - 114 months （36.1 months old in average）, and the 1-, 2-, and 3-year survival rates were 100% （7/7）, 86% （6/7）, and 71% （5/7）. 6 patients underwent TACE treatment successfully received surgical resection, followed by systemic chemotherapy, and 1 case after only 4 times TACE therapy and chemotherapy without surgery, the tumors disappeared, all without any tumor till now. However, 3 patients gave up treatment treatment died after 2 - 6 months. Conclusions TACE can be used as an important preoperative adjuvant therapy of HB. It can make the tumor shrink significantly, decrease the blood supply, and let the tumor capsular thickening, then it