术前经动脉化疗栓塞在肝母细胞瘤治疗中的应用

目的 探讨肝母细胞瘤术前介入性肝动脉化疗栓塞(transarterial chemoembolization，TACE)的临床可行性、疗效及适应证及在综合治疗中的地位。方法 对常规估计不能切除的13例肝母细胞瘤先行经动脉化疗栓塞，再行Ⅱ期外科手术切除，观察分析患儿临床症状的变化反应、术中情况和远期疗效。结果 TACE术后数天至1个月复查，肿瘤体积明显缩小7．5％～66．3％(平均38．0％)，AFP水平显著降低11％～61．2％(平均52．3％)，无明显的化疗毒性反应，TACE后其中11例患儿都安全地施行外科手术，手术切除标本的病理改变肿瘤明显坏死，平均坏死区域面积达70．9％。介入后2年死于肺转移1例，介入后3年死于肺、脑转移的1例，肝移植后死亡1例，3个月后肝衰竭者1例，3例复发，无瘤存活6例，其平均生存期22．3个月，平均随访时间为30个月。结论 TACE能有效杀死肿瘤细胞，控制肿瘤生长，使部分不能Ⅰ期手术的患儿重新获得手术机会，改善预后，无严重并发症，是一种安全、有效、实用的肝母细胞瘤的辅助治疗方法，而且对防止术中肿瘤细胞的扩散也有一定的作用。

Application o preoperative transcatheter arterial chemoembolization in treatment of hepatoblastoma

Objective To investigate the feasibility, therapeutic effect, applications and role of the preoperative arterial transarterial chemoembolization (TACE) in treatment of hepatoblastoma in infants. Methods Thirteen cases of unresectable hepatoblastoma received TACE and then underwent surgical resection. TACE was performed at the time of initial hepatic angiography under general anesthesia. The changes in clinical symptoms and during the operation and long-term therapeutic effect of preoperative TACE were observed in all the 13 cases. Results The re-examination conducted 1d to 1 month later showed that the tumor size significantly shrank for 7.5%-66.3% (mean = 38.0%) and AFP level markedly decreased for 11%-61.2% (mean = 52.3%). No marked side effects of chemotherapeutic reagents were observed after TACE and 11 cases were safely treated with surgery. Pathological examination showed there was massive necrotic area in the tumor and the mean percentage of the necrotic area was 70.9%. One patient died from pulmonary metastasis 2 years and another from brain and pulmonary metastasis 3 years after TACE. One patient treated with liver transplantation and the other suffering from liver failure died in 2 d and 3 months, respectively, after TACE. Tumor recurrence appeared in 3 patients. The follow-up study for 30 months in the remaining 6 patients showed that their mean survival duration was 22.3 months. Conclusions TACE can effectively kill tumor cells and control tumor growth. Meanwhile, it can provide chance of surgery for those children with unresectable hepatoblastoma. TACE is effective in not only treatment of unresectable hepatoblastoma but also the preoperative management of the tumor to prevent tumor cell dissemination during the operative procedure.