26例婴儿肝脏肿瘤的临床与病理相关性分析

目的 探讨婴儿肝脏肿瘤的临床病理特点及肿瘤标志物水平与组织病理类型之间的关系.方法 回顾性分析2000年4月至2010年4月本院收治的26例肝脏肿瘤婴儿的临床病理资料.结果 26例肝脏肿瘤患儿中,23例行一期手术,术后均经组织病理检查确诊.其中肝脏恶性肿瘤16例,以肝母细胞瘤为主（15/16）;肝脏良性肿瘤7例,以肝血管瘤（3/7）和肝错构瘤为主（3/7）.婴儿肝脏恶性与良性肿瘤比为2.29∶1,发病以恶性肿瘤为主,但肝脏良恶性肿瘤之间年龄分布及临床表现比较无统计学意义（P＞0.05）.肝脏恶性肿瘤婴儿AFP水平明显超出同年龄段正常水平,与良性肿瘤相比,AFP阳性率差异有显著统计学意义（P=0.007）.结合术后病理结果,患儿术前诊断正确率达95.65%.23例手术患儿肿瘤均成功切除,3例患儿家长放弃治疗.讨论婴儿肝脏良恶性肿瘤的临床表现缺乏特异性,首发症状以腹部肿块多见.多数肝脏肿瘤患儿尽管肿瘤巨大,病变累及肝门,但肿瘤周围多有假性包膜形成,其与肝门的关系往往是推挤压迫,而不是浸润包埋,肿瘤多可成功手术切除.监测不同年龄段患儿AFP水平,并与生理性AFP水平进行比较,有助于婴儿肝脏肿瘤的早期诊断及良恶性鉴别.

Clinicopathological correlative analysis in infants with liver tumor

Objective To discuss the clinical and pathological characteristics of liver tumor in infants and the relationship between tumor markers＇ level and histopathology. Methods We retrospectively evaluated 26 liver tumor infants who admitted in our hospital between April 2000 to April 2010. Results Among 26 infants, 23 underwent an integrity resection of liver tumor and diagnosed by the results of histopathology . Malignant liver tumor was more often than benign tumor and the ratio of them was 2.29 ： 1 . The majority of malignant liver tumor was hepatoblastoma （15/16） and most benign tumors were hemangioma（3/7） and hamartoma （3/ 7 ）. The rate of AFP （ ＋ ） was higher for malignant liver tumor than that of benign tumor with statistical significant difference （ P = 0. 007 ）. Whereas the prevalence of age and clinical symptoms had no statistical difference （ P 〉 0.05 ）. The three other infants gave up therapy eventually. Conclusions The majority clinical symptom of liver tumor is abdominal mass , and most of them have no specific characteristics. We believe that many pediatric liver tumor may have well defined margins and tend to compress, rather than infiltrate or become embedded on the hepatic hilum, although this type of tumor may be enormous. The resected giant liver tumors involving the main hepatic veins and/or the retrohepatic vena cava, although challenging, is feasible and safe. The AFP levels correlate with tumor classification even in patients less than 1 year of age . Despite the baseline AFP levels are elevated within these populations , we conclude that AFP levels can be valuable in differentiating malignant from benign liver tumors and in predicting prognosis.