超声引导下穿刺活检诊断小儿肝母细胞瘤

目的 探讨超声引导下穿刺活检在小儿肝母细胞瘤诊断中的应用价值.方法 对2008年1月至2010年12月上海交通大学医学院附属新华医院收治的19例小儿肝脏肿块进行超声检查,根据声像图特点在超声引导下对肝脏肿块进行穿刺活检病理组织学检查.结果 19例小儿肝脏肿块巨大,为74 mm×63 mm×68 mm～105 mm×83 mm×87 mm,平均(89.9±8.3)mm,位于肝右叶14例,同时累及肝左右叶5例;肝内肿瘤多呈单个球形(12例)或分叶状融合的实性肿块(7例);边界清,回声多不均匀(等回声6例,低回声3例,强回声5例,混合回声5例,8例伴有钙化,6例伴有出血坏死);肿瘤周边肝实质正常.超声引导下肿块穿刺获取病变组织均为一次成功(19/19),无并发症发生.病理分型诊断:胎儿型9例,胚胎型5例,胎儿型与胚胎混合型5例.结论 根据超声声像图特点,在超声引导对小儿肝脏肿块进行穿刺活检安全有效,可对小儿肝母细胞瘤作出明确诊断,对指导小儿肝母细胞瘤的临床手术和治疗有重要应用价值.

Clinical value of ultrasound-guided core needle biopsy in diagnosis of hepatoblastoma in children

Objective To evaluate the value of ultrasound guided core needle biopsy in diagnosis of hepatoblastoma in children. Methods A total of 19 children with liver masses were underwent ultrasonography between January 2008 and December 2010. Meanwhile ,ultrasound guided core needle biopsy was performed for pathological tissues acquirement. Results The size of liver masses was in the range from 74mm×63irlm×68mm-105mm×83mm×87mm, the mean diameter was （89.9±8.3）mm,Among 19 children with liver masses, 14 cases located on right liver lobe, and 5 cases located on both right and left liver lobes ; 12 cases were simple spheroid, while 7 cases were lobular, circumscribed,inhomogeneous echo （6 cases of isoechoic pattern, 3 cases of hypoechoic pattern,5 cases of hypereehoie pattern,5 cases of mixed echo pattern ,8 cases with calcifications ,6 cases with necrosis）. The liver tissue around the tumor was normal. All children were performed ultrasound guided core needle biopsy. The procedure of puncture was successful in all children（ 19/19 ） , no complication was happened. According to pathology staging,9 cases were baby＇ s type,5 cases were embryo type,5 cases were hybrid type. Conclusion Hepatoblastoma could be diagnosed according to uhrasonography appearance and ultrasound guided core needle biopsy. Ultrasound guided core needle biopsy is a safe and reliable method for the diagnosis of liver masses in children, and plays an important role in the treatment of hepatoblastoma in children.