术前化疗治疗肝母细胞瘤的应用价值

目的 通过总结22例经病理组织学确诊的肝母细胞瘤病例术前化疗的治疗效果,评价术前化疗对治疗肝母细胞瘤的应用价值.方法 回顾本院2000年3月至2006年12月期间收治的22例肝母细胞瘤的治疗经过,包括化疗前确诊方法、化疗方式、方案,手术时机的选择,治疗效果.结果本组化疗前采用B超引导下细针穿刺活检18例,明确诊断为肝母细胞瘤15例,疑似者3例.本组未经术前化疗I期手术切除肿瘤3例.经术前化疗并完成疗程延期手术14例,其中介入治疗2例,全身化疗12例,肿瘤体积在化疗后较化疗前平均缩小55.7%,完整切除肿瘤13例,肿瘤仍不能切除仅活检1例,化疗后肿瘤完整切除率为92.9%.化疗1～2个疗程后放弃继续治疗3例,化疗期间死亡1例.外院初次手术后肿瘤复发行肝移植1例,术后死于腹腔内出血.本组术后超过2年者10例,因肿瘤复发、转移死亡2例,术后不足2年者6例,存活5例,1例术后8个月时因肿瘤复发死亡.化疗后仅行活检者术后6个月死亡.结论化疗前必须经病理学确诊,采用B超引导下细针穿刺活检具有损伤小,确诊率高的特点.对不能工期切除的肿瘤,无论采用介入治疗或全身化疗均可使肿瘤明显缩小,对提高肝母细胞瘤的肿瘤完整切除率有很大的帮助.

The value of pre-operative chemotherapy for hepatoblastoma

Objective To evaluate the pre-operative chemotherapy for hepatoblastoma by summarizing 22 patients with hepatoblastoma.Methods Therapeutical courses of 22 patients with hepatoblastoma were retrospectively studied from March 2000 to December 2006 in our hospital,including the method of definite diagnosis,the scheme of chemotherapy,the indication for surgical intervention and the outcomes.Results Eighteen patients of 22 accepted fine needle aspiration biopsy by the guidance of type-B sonography.And fifteen of the 18 patients above-mentioned were proved to be hepatoblastoma.while another 3 were suspectable.Of all the 22 patients,3 patients underwent direct reseetion and 1 patient(died from post-operative intro-abdominal hemorrhage)was performed liver transplantation because of the recurrence after the resection by another hospital.AnOther 18 patients were treated by chemotherapy.4 of whom didn't continue the following treatment(three gave up,1 died during the chemotherapy).Fourteen patients got through the chemotherapy courses(two accepted interventional therapy,12 accepted intravenous injeetion)and were undertaken the delayed operation,13 of whose tumor(13/14,92.86%)could been resected completely.Of the 10 patients who accepted the treatment for more than 2 years ago,two died because of recurrence and metastasis.Of the 6 patients who accepted treatment for 1ess than 2 years,five survived by now,one patient died 8 months after operation due to recurrence.One patient who only underwent biopsy after chemotherapy died 6 months later.Conclusions The pathological diagnosis is compulsory before chemotherapy,fine needle aspiration biopsy by the guidance of type-B sonography is proved to be less traumatic and has higher definite diagnostic ratio.For the unresectable hepatoblastomas,chemotherapy can reduce their size either by intervention or intravenous injection,which can consequently increase the chance of en bloc resection.