摘要
目的探讨小儿肝母细胞瘤的诊疗经验及新思路。方法 2006年4月-2010年3月本科共诊治15例经病理检查确诊为肝母细胞瘤的患儿。男12例,女3例;中位年龄1.83岁(0.5～11.5岁)。甲胎蛋白(AFP)增高14例,正常1例;临床分期:Ⅰ期2例,Ⅱ期1例,Ⅲ期5例,Ⅳ期7例;病理分型:上皮型4例,胚胎型4例,间叶型1例,混合型6例。一期手术3例,二期手术11例,未行手术治疗1例。12例术前经1～4个周期化疗治疗后行手术治疗,术后均行依托泊苷+顺铂+吡柔比星(AEP)/环磷酰胺+顺铂+吡柔比星(ACP)化疗方案交替化疗,1例患儿因全身广泛转移,于术后规律化疗2个疗程后行自体外周血干细胞移植治疗。化疗采用AEP/ACP方案交替治疗。结果 15例患儿中有效13例(86.6%),其中完全缓解11例(73.3%),部分缓解2例;无效2例。1例无效患儿行自体外周血干细胞移植后达部分缓解,3个月后因脑转移死亡,1例无效病例放弃治疗。随访至2010年3月31日,中位时间15.5个月(4.0～33.0个月),剔除放弃治疗后死亡1例及失访1例,疾病长期处于完全缓解达69.2%(9/13例),存活率为76.9%(10/13例)。结论小儿肝母细胞瘤对化疗敏感,化疗可有效缓解其病情。晚期肝母细胞瘤患儿行自体外周血干细胞移植治疗,可在一定程度上延长患儿生存时间,提高临床缓解率。
Objective To explore the consultation issues of hepatoblastoma in children and the new consideration.Methods From Apr.2006 to Mar.2010,15 children were diagnosed as hepatoblastoma（12 cases were male and 3 cases were female）by pathological examination.The medium age at diagnosis was 1.83 years old（ranged 0.5-11.5 years old）.Serum alpha fetoprotein（AFP）level in 14 patients markedly increased,and 1 case had normal serum AFP level.Two cases had this disease of stage Ⅰ,1 case with stage Ⅱ,5 cases with stage Ⅲ,7 cases with stage Ⅳ.Pathological types：4 cases were epithelioid,4 cases were embryonic types,1 case was separate vane type,and 6 cases were composite types.Three patients had primary surgery while 11 patients had pre-operation chemotherapy before surgery,and 1 patient gave up treatment.Twelve cases had operation after 1-4 periods of chemotherapy.AEP/ACP chemotherapy therapy was used totally,1 patient received high dose of chemotherapy combined with autologous peripheral blood stem cell transplantation because of extensive diversion.Results Thirteen patients responded to treatment（86.6%）and 2 cases failed.Eleven patients achieved complete remission after treatment,and 2 cases had partial remission.By Mar.31st,2010,except for 1 dead case and 1 case of missing follow up information were elimintia-ted,8 patients（69.2%,9/13 cases）survived without any event.The overall survival rate was 76.9%（10/13 cases）.Conclusions Children with hepatoblastoma are very sensitivie to chemotherapy.High dose of chemotherapy combined with autologous peripheralstem cell transplantation is a good way to treat the patients with stage Ⅳ hepatoblastoma.It can prolong hopefully the survival time hopefully and increase the clinical remission rate.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2010年第19期1489-1491,共3页
Journal of Applied Clinical Pediatrics
关键词
肝母细胞瘤
化疗
自体外周血干细胞移植
儿童
hepatoblastoma
chemotherapy
autologous peripheral blood stem cell transplantation
child
