肝动脉栓塞化疗及延期手术治疗小儿切除困难的肝母细胞瘤

自2003年1月至2005年2月我科共收治小儿肝母细胞瘤8例，其中5例经B超，CT或MRI等检查临床诊断为ⅢA期肝母细胞瘤，无法Ⅰ期手术完整切除，行肝动脉栓塞化疗（TACE）疗程后均能完整切除肿瘤，无手术死亡病例，存活最长已2年，平均存活时间11个月，无肿瘤复发或转移。     

42例婴儿肝母细胞瘤的临床特点及长期随访预后分析

目的 探讨婴儿期肝母细胞瘤(HB)患者的临床特点及影响其长期生存的预后因素.方法 回顾性分析2007年1月1日-2017年12月31日我院收治的42例婴儿HB的电子病历系统及随访资料,总结婴儿HB的临床特点;并采用Log-rank检验进行单因素分析,Cox回归进行多因素分析影响HB婴儿长期生存的预后因素.结果 42例患...     

不可切除型肝母细胞瘤的术前介入治疗临床研究

目的探讨术前介入性动脉栓塞化疗（TACE）在不可切除型肝母细胞瘤治疗中的可行性。方法分析对8例经检查诊断为不可切除型肝母细胞瘤行TACE的治疗结果。结果8例患儿TACE后均有不同程度呕吐、发热、一过性肝功能损害，1例有骨髓抑制，无心、肾功能损害。有6例复查B超检查，肿瘤体积较前均有明显缩小，缩小比例为22．5％～57．5％；5例手术完整切除，均已无瘤存活1～4年，3例复诊检查发现有肺转移或多发转移，家属放弃进一步治疗后死亡。结论TACE具有化疗药物剂量小、全身副作用少、化疗效果好的优点，可作为一种术前治疗方法应用于不可切除型肝母细胞瘤。     

经导管动脉化疗栓塞联合手术治疗儿童肝母细胞瘤

目的 探讨对不能切除的小儿肝母细胞瘤实行动脉化疗栓塞术(TACE)治疗的临床可行性、疗效及作用.方法 8例常规不能切除的肝母细胞瘤经TACE治疗20次,再行Ⅱ期外科手术切除,比较分析治疗前后临床症状、体征和血AFP的变化、术中情况及随访远期疗效.结果 TACE术后4～6周复查,和术前相比.肿瘤体积缩小67.68%～95.91%,平均缩小87.91%(t=3.754,P=0.007),血AFP下降94.46%～99.97%,平均98.45%(t=2.931,P=0.022),无明显的化疗毒性反应,所有患儿手术完整切除肿瘤,术后病理显示肿瘤明显坏死.随访8～24个月,所有患儿均获无瘤生存.结论 TACE治疗肝母细胞瘤安全有效,无严重并发症,能使部分不能Ⅰ期手术的患儿重新获得手术机会,并对减少术中肿瘤细胞的扩散和术中出血、改善预后有较大作用,可作为无远处转移肝母细胞瘤的术前辅助治疗.     

数字减影血管造影应用于小儿缺血性脑血管病的诊断与介入治疗

目的 探讨数字减影血管造影(DSA)在小儿缺血性脑血管病中的诊断和介入治疗的价值.方法 31例疑有缺血性脑血管病的患儿经DSA确定部位后,再通过导管注入尿激酶、右旋糖酐以观察注药后血管影像学变化,同时观察临床症状及体征有否改善.结果 31例中24例(77%)示脑血管异常改变,其中脑动静脉畸形2例,后交通动脉瘤1例,大脑动脉狭窄或闭塞病变21例.21例脑动脉狭窄或闭塞病变者行介入灌注治疗后,即刻观察肌力变化有不同程度提高.其中肌力提高Ⅰ级的13例,提高2级的3例,提高3级的2例,无明显改善的3例.即刻肌力提高率达86%.7例狭窄血管100%开通;血管闭塞12例,完全再通3例,部分再通7例,不通2例.结论 DSA能够提高缺血性脑血管病的检出率,是评价脑血管狭窄、闭塞和选择治疗方案的金标准,它对缺血性脑血管病的进一步治疗起着决定性的作用.     

102例儿童肝母细胞瘤的治疗及预后分析

目的分析儿童肝母细胞瘤(HB)手术结合化疗的疗效及预后,了解风险因素对预后的影响。方法 2006年9月-2014年6月北京同仁医院收治HB患儿102例。男55例,女47例。通过分析临床资料,研究HB的临床疗效及预后。结果 102例患儿经综合治疗后完全缓解(CR)52例占51.0%,部分缓解(PR)20例占19.6%,死亡28例占27.4%,进展2例(2.0%)。随访至2015年1月1日,平均随访时间27.54±19.95个月,2年总生存率(0S)76.5%,3年无事件生存(EFS)60.5%。对随访时间超过12个月的81例患儿进行Kaplan-Meier生存分析,5年平均生存时间71.1个月,95%可信区间61.2~80.9个月。结论儿童HB经规律化疗结合手术治疗后疗效肯定,但应对PLT、反复复发以及远处转移病例加强随访预防复发。     

肝母细胞瘤的介入治疗

一般认为，小儿肝母细胞瘤能够治愈的标准是能够手术Ⅰ期切除，如果没有或者不能进行手术Ⅰ期切除，则通常认为预后不良，我们应用介入的方法，对1例失去手术机会的晚期肝母细胞瘤患儿进行了4次介入治疗后，患儿肿瘤完全消失，正常肝脏组织完全代替肿瘤组织，随访5年，患儿健康生长，无任何不适。现将我们的治疗经验报告如下。     

儿童晚期肝母细胞瘤综合治疗的疗效观察

目的 总结晚期肝母细胞瘤(HB)患儿的临床治疗结果,探讨晚期HB的临床疗效及诊疗经验.方法 回顾性分析2006年4月至2012年8月北京同仁医院儿科收治的40例经病理确诊及分期明确的晚期HB患儿(男29例,女11例;发病年龄3个月～11岁6个月,中位年龄1.9岁)的病例资料,根据美国儿童肿瘤组织肝母细胞瘤国际分期分为Ⅲ期15例,Ⅳ期25例,采用多科室协作模式进行治疗.结果 随访至2012年8月,中位随访时间为21个月(1 ～ 67个月),失访1例,余39例患儿获随访,死亡12例(其中1例为进展期放弃治疗死亡,1例化疗中合并脏器衰竭死亡),完全缓解及部分缓解共27例(其中1例为进展期放弃治疗至随访日仍存活),总生存率为69.2％(27/39例).结论 晚期HB儿童一旦伴有远处组织器官转移预后较差,但综合治疗仍可延长患儿生存期及提高临床缓解率.     

支气管动脉畸形咯血的栓塞治疗

引起咯血的原因很多 ,但因支气管动脉畸形引起的咯血报道较少 ,现将我们 1996～ 1999年收治的 4例报告如下。临床资料一、一般资料　咯血 4例中男 3例 ,女 1例 ,年龄 10～16ａ ,均因反复咯血多次入院。每次咯血量 5 0～ 2 5 0ｍｌ左右 ,新鲜血 ,经体检、胸片、ＣＴ、纤支镜、支气管碘油造影等检查 ,均未见异常改变。排除肺部疾病引起的咯血后 ,经内科保守治疗 ,症状缓解 ,但未能根治患儿。采用支气管动脉畸形的数字减影 (ＤＳＡ)帮助明确诊断。二、方法　采用Ｓｅｌｄｉｎｇｅｒ技术穿刺股动脉插管 (Ｃ3导管 ) ,将导管选择性插入靶血管 ,经…     

Preliminary experience with arterial chemoembolization for hepatoblastoma and hepatocellular carcinoma in children

The objective of this work was to test feasibility and efficacy of hepatic artery chemoembolization (HACE) in unresectable malignant liver tumors. Five patients aged from 1-12 years were treated in the Medical University of Gdansk from 1999 to 2002. All had locally advanced tumors, which did not respond to systemic chemotherapy: four, hepatoblastoma (HB) and one, hepatocellular carcinoma (HCC). Arteriography was performed and chemoembolization suspension (cisplatin + doxorubicin + mitomycin mixed with lipiodol) was injected, followed by gelatin foam particles. The procedure was performed one to three times in each patient. In four patients (three, HB, one, fibrolamellar HCC), tumor response was observed, with decrease in the diameter of the mass of 25-33% and fall in the AFP level of 83-99%. One child with HB was non-evaluable due to early death caused by systemic myelotoxicity. Two patients (2 HB) underwent macroscopically complete tumor resection, 1 is alive and well, and 1 died at the end of surgery for an unknown reason (possibly related to cardiotoxicity of earlier systemic chemotherapy). One HB patient was successfully transplanted after two HACE courses. The only HCC patient died because of pulmonary oil embolism immediately after the third HACE course. HACE can lead to tumor regression in most cases and may be considered an alternative for patients with unresectable liver tumors who do not respond to primary systemic chemotherapy and are not candidates for liver transplantation for various reasons.     

Transarterial chemoembolization in children to treat unresectable hepatocellular carcinoma

Children with unresectable HCC have a dismal prognosis and few approved treatment options. TACE is an effective treatment option for adults with HCC , but experience in children is very limited. Retrospective analysis was performed of 8 patients aged 4‐17 years (4 male, mean 12.5 years) who underwent TACE for unresectable HCC . Response to TACE was evaluated by change in AFP , RECIST and tumor volume, PRETEXT , and transplantation eligibility by UCSF and Milan criteria. Post‐procedure mean follow‐up was 8.2 years. Mean overall change in tumor volume for the 8 patients was 51%. Percent change in AFP ranged from a decrease of 100% to an increase of 89.3%, with a mean change of ?49.6%. Two patients did not undergo resection or transplantation and died of progressive disease. Six patients underwent orthotopic liver transplantation with mean first TACE ‐to‐transplant interval of 141 days (range 11‐514). Following transplantation, 5 patients were alive at the end of the follow‐up period and one died of recurrent disease. Based on our initial experience, TACE for children with unresectable HCC appears to be a safe and effective method for managing hepatic tumor burden and for downstaging and bridging to liver transplantation.     

Sialoblastoma and hepatoblastoma in a newborn infant

We report a case of a newborn infant who had simultaneous sialoblastoma and hepatoblastoma tumours at birth. The diagnoses were made on post mortem examination. Both of these are rare tumours in the neonatal period. Pediatr Blood Cancer 2009;52:883–885. © 2009 Wiley‐Liss, Inc.     

Combined treatment of hepatoblastoma with transcatheter arterial chemoembolization and surgery

Hepatoblastoma (HB) frequently presents at an advanced and unresectable stage. Transcatheter arterial chemoembolization (TACE) had been attempted to improve the feasibility of removing the bulky tumor in the authors' hospital and the results were presented here to evaluate the effectiveness and therapeutic role of TACE in the HB infants. Eight patients (6 boys, 2 girls), ranging in age from 2 months to 12 months, had unresectable HB based on clinical manifestation, B-ultrasound (B-US), chest X-ray film, computed tomography (CT), blood chemistry, and serum alpha-fetoprotein (AFP), and were subjected to TACE 1-3 times. On each TACE, Adriamycin (ADR, 20 mg/m2), vincristine (VCR, 1.5 mg/m2), and cisplatin (CDDP, 40 mg/m2) dispersed in 5-10 mL lipiodol were infused into the tumor, and stainless-steel embolization coils were released into the main feeding artery until completely embolized. Then, all the patients were reexamined once a month. Digital subtractive angiography was performed and the therapeutic strategy of further TACE or surgery was individualized in terms of the changes of tumor stain and the newly forming feeding artery. Six children (75%) had a marked response after the first TACE and were judged as being surgically resectable, but one boy died of pneumonia just before the scheduled operation and another boy preferred further TACE. The other 2 patients had only a partial response and required further TACE before the operation. Thus 6 children eventually underwent complete surgical resection and 1 boy achieved successful disappearance of tumor after 3 episodes of TACE alone. Seven children had an excellent recovery and remained tumor-free for 15-49 months. The results indicate that TACE is an effective and useful preoperative therapeutic choice for unresectable hepatoblastoma, and can improve the resectablity of the bulky tumor and the survival rate of HB patients. Multiple TACE could enhance the therapeutic effect and should be considered if indicated.     

介入栓塞治疗后手术切除肝母细胞瘤

目的 评价介入栓塞对肝母细胞瘤的手术切除率及预后的影响.方法 回顾性分析2006年1月至2011年12月介入栓塞后经手术治疗的肝母细胞瘤33例患儿的临床资料.本组术前予介入栓塞治疗2～4个疗程后,均可手术切除,术后2周均予辅助化疗.结果 所有病例均获得肿瘤的完整切除,手术效果良好,术后随访6个月～5年,存活30例.结论 术前介入栓塞治疗可减少肿瘤血供,缩小肿瘤体积,提高手术切除率,综合治疗后可提高生存率.     

Hepatic arterial chemoembolization as an initial treatment for hepatoblastoma

Hepatic arterial chemoembolization using Lipiodol Ultra-fluid (Laboratoire Guerbet), doxorubicin HCl, and Gelfoam (Upjohn)(L-TAE) produced good results in an infant with a hepatoblastoma initially considered to be difficult to resect. Lipiodol selectively accumulated in the tumor, and a marked reduction in tumor size with decrease of alpha-fetoprotein was observed. One month after L-TAE, left hepatectomy was performed uneventfully with a good postoperative course. L-TAE appears to be a useful treatment for hepatoblastoma. Offprint requests to: I. Yamagiwa     

Chemotherapeutic approaches for newly diagnosed hepatoblastoma: Past, present, and future strategies

Surgical resection is the foundation of therapy in hepatoblastoma (HB), yet most patients have unresectable tumors at diagnosis 1 . Patients with resectable tumors have event‐free survival (EFS) of 80–90% and can be cured with cisplatin, 5‐fluorouracil, and vincristine. Patients whose tumors are unresectable but without overt metastases at diagnosis have EFS of 60–70%, and many can be rendered resectable without doxorubicin. Children with metastatic disease have fared poorly with 20–50% EFS 1 - 3 , and new approaches for these patients remain desperately needed. Dose intensification of cisplatin and doxorubicin appears beneficial in high‐risk patients. Future treatment strategies, which may be useful, include increasing intensity and/or duration of therapy, developing a maintenance regimen (oral irinotecan), using liver transplantation more often for patients to undergo complete resection, and identifying and incorporating novel agents. A better understanding of the biologic and pathologic factors is critical for predicting tumor behavior and developing more logical risk‐based treatments. Pediatr Blood Cancer 2012; 59: 809–812. © 2012 Wiley Periodicals, Inc.