Lin Yu,Wang Huanmin,Yang Shen,et al.Preliminary exploration of transcatheter arterial embolization for ruptured hepatoblastoma[J].Journal of Clinical Pediatric Surgery,2023,22(12):1109-1113.[doi:10.3760/cma.j.cn101785-202310011-003]
经导管动脉栓塞术治疗肝母细胞瘤破裂的初步探索
- Title:
- Preliminary exploration of transcatheter arterial embolization for ruptured hepatoblastoma
- Keywords:
- Hepatoblastoma; Rupture; Endovascular Procedures; Embolization; Therapeutic; Postoperative Complications; Therapy; Prognosis; Child
- 摘要:
- 目的 探讨经导管动脉栓塞术(transcatheter arterial embolization,TAE)在肝母细胞瘤(hepatoblastoma,HB)破裂中的治疗价值。方法 回顾性收集2021年3月至2023年5月首都医科大学附属北京儿童医院收治的10例接受TAE治疗的HB破裂患儿临床资料,总结分析患儿临床特点、实验室及影像学检查特点与预后。结果 本研究共纳入10例患儿,其中男1例,女9例。发病月龄为21.5(13.3,45.3)个月,初诊时肿瘤长径13.0(10.8,15.3)cm,甲胎蛋白(alpha fetoprotein,AFP)均明显升高[443 641(137 598,877 500)ng/mL]。肿瘤破裂后血红蛋白和红细胞计数均下降,低谷血红蛋白69.0(56.3,85.8)g/L。根据PRETEXT术前分期系统,Ⅱ期1例、Ⅲ期7例、Ⅳ期2例。患儿均接受TAE治疗,其中9例成功止血。随访时间15.00(3.75,19.25)个月。9例生存,1例死亡。结论 HB破裂临床罕见,治疗难度大,患儿常伴有肿瘤负荷大、一般情况差、血色素进行性下降等。TAE是其有效治疗方式。对于预期药物止血效果欠佳的患儿,建议尽早行介入治疗以达到止血目的。
- Abstract:
- Objective To explore the application of transcatheter arterial embolization (TAE) for ruptured hepatoblastoma (HB).Methods From March 2021 to May 2023,clinical characteristics,laboratory examinations,imaging features and outcomes were retrospectively reviewed for 10 children with ruptured HB undergoing TAE.Results There were 1 boy and 9 girls with a median onset age of 21.5(13.3,45.3) months.The median tumor diameter at diagnosis was 13.0(10.8,15.3) cm.Alpha fetoprotein (AFP) was elevated at an initial diagnosis.And the median value of AFP was 443641(137598,877500) ng/ml.After rupture,hemoglobin and erythrocyte declined and the median trough value of hemoglobin was 69.0(56.3,85.8) g/L.According to the PRETEXT preoperative staging system,the stages Ⅱ (n=1),Ⅲ (n=7) and Ⅳ (n=2).The frequency of TAE was once (n=7) and twice (n=3).After TAE,9/10 cases achieved successful hemostasis.During a median follow-up period of 15.00(3.75,19.25) month,9 patients survived and 1 died.Conclusions HB rupture is quite rare and difficult to treat.There are a heavy tumor burden,poor general status and a progressive decline of hemoglobin.For children responding poorly to hemostatic agents,interventional therapy is recommended.
参考文献/References:
[1] Hadzic N,Finegold MJ.Liver neoplasia in children[J].Clin Liver Dis,2011,15(2):443-462.DOI:10.1016/j.cld.2011.03.011.
[2] Pondrom M,Pariente D,Mallon B,et al.Tumor rupture in hepatoblastoma:a high risk factor?[J].Pediatr Blood Cancer,2020,67(9):e28549.DOI:10.1002/pbc.28549.
[3] Fung KFK,Liu APY,Chung PHY,et al.Management of acute intra-abdominal hemorrhage in ruptured hepatoblastoma with transarterial embolization using calibrated gelfoam particles[J].Pediatr Blood Cancer,2023,70(1):e30019.DOI:10.1002/pbc.30019.
[4] Hiyama E.Pediatric hepatoblastoma:diagnosis and treatment[J].Transl Pediatr,2014,3(4):293-299.DOI:10.3978/j.issn.2224-4336.2014.09.01.
[5] Lai ECH,Lau WY.Spontaneous rupture of hepatocellular carcinoma:a systematic review[J].Arch Surg,2006,141(2):191-198.DOI:10.1001/archsurg.141.2.191.
[6] Krauel L,Albert A,Mora J,et al.Use of angioembolization as an effective technique for the management of pediatric solid tumors[J].J Pediatr Surg,2009,44(9):1848-1855.DOI:10.1016/j.jpedsurg.2009.04.037.
[7] Chan KL,Tam PK.Successful right trisegmentectomy for ruptured hepatoblastoma with preoperative transcatheter arterial embolization[J].J Pediatr Surg,1998,33(5):783-786.DOI:10.1016/s0022-3468(98)90221-4.
[8] Towbin AJ,Meyers RL,Woodley H,et al.2017 PRETEXT:radiologic staging system for primary hepatic malignancies of childhood revised for the Paediatric Hepatic International Tumour Trial (PHITT)[J].Pediatr Radiol,2018,48(4):536-554.DOI:10.1007/s00247-018-4078-z.
[9] 中国抗癌协会小儿肿瘤专业委员会,中华医学会小儿外科分会肿瘤专业组.儿童肝母细胞瘤多学科诊疗专家共识(CCCG-HB-2016)[J].中华小儿外科杂志,2017,38(10):733-739.DOI:10.3760/cma.j.issn.0253-3006.2017.10.003. Specialty Committee of Pediatric Oncoology,Chinese Anti-Cancer Association; Specialty Group of Oncology,Branch of Pediatric Surgery,Chinese Medical Association:Expert Consensus for Multidisciplinary Management of Hepatoblastoma (CCCG-HB-2016)[J].Chin J Pediatr Surg,2017,38(10):733-739.DOI:10.3760/cma.j.issn.0253-3006.2017.10.003.
[10] Meyers RL,Maibach R,Hiyama E,et al.Risk-stratified staging in paediatric hepatoblastoma:a unified analysis from the Children’s Hepatic tumors International Collaboration[J].Lancet Oncol,2017,18(1):122-131.DOI:10.1016/S1470-2045(16)30598-8.
[11] Aronson DC,Czauderna P,Maibach R,et al.The treatment of hepatoblastoma:its evolution and the current status as per the SIOPEL trials[J].J Indian Assoc Pediatr Surg,2014,19(4):201-207.DOI:10.4103/0971-9261.142001.
[12] Chang SS,Yang S,Yang W,et al.Clinical risk factors for patients with ruptured hepatoblastoma in children:a retrospective study from a single center in China[J].Pediatr Surg Int,2023,39(1):76.DOI:10.1007/s00383-022-05362-1.
[13] 邹焱,何小兵,张靖,等.介入栓塞治疗后手术切除肝母细胞瘤[J].中华小儿外科杂志,2012,33(12):897-900.DOI:10.3760/cma.j.issn.0253-3006.2012.12.005. Zou Y,He XB,Zhang J,et al.Combinational therapy of preoperative transcatheter arterial chemoembolization and surgery for hepatoblastoma[J].Chin J Pediatr Surg,2012,33(12):897-900.DOI:10.3760/cma.j.issn.0253-3006.2012.12.005.
[14] 胡显良,沈文律,李建宏,等.婴儿肝母细胞瘤的介入治疗及延迟手术治疗[J].实用儿科临床杂志,2004,19(9):793-795.DOI:10.3969/j.issn.1003-515X.2004.09.036. Hu XL,Shen WL,Li JH,et al.Transcatheter arterial chemoembolization and delayed surgery for infantile hepatoblastoma[J].Chin J Appl Clin Pediatr,2004,19(9):793-795.DOI:10.3969/j.issn.1003-515X.2004.09.036.
[15] Sahu SK,Chawla YK,Dhiman RK,et al.Rupture of hepatocellular carcinoma:a review of literature[J].J Clin Exp Hepatol,2019,9(2):245-256.DOI:10.1016/j.jceh.2018.04.002.
[16] Lin CH,Hsieh HF,Yu JC,et al.Peritoneal lavage with distilled water during liver resection in patients with spontaneously ruptured hepatocellular carcinomas[J].J Surg Oncol,2006,94(3):255-256.DOI:10.1002/jso.20596.
相似文献/References:
[1]陈立才,李朋飞,黄一敏,等. 抗EpCAM单克隆抗体治疗肝母细胞瘤的动物实验研究[J].临床小儿外科杂志,2019,18(01):63.
Chen Licai,Li Pengfei,Huang Yimin,et al. Targeting therapy of antiEpCAM monoclonal antibody in hepatoblastoma animal model.[J].Journal of Clinical Pediatric Surgery,2019,18(12):63.
[2]成英杰,单慈,石寒菡,等.MicroRNAs在肝母细胞瘤诊断、鉴别诊断及预后评估中的研究进展[J].临床小儿外科杂志,2019,18(08):660.[doi:10.3969/j.issn.1671-6353.2019.08.009]
Cheng Yingjie,Shan Ci,Shi Hanhan,et al.Research advances of MicroRNAs in the diagnosis,differential diagnosis and prognostic evaluation of hepatoblastoma[J].Journal of Clinical Pediatric Surgery,2019,18(12):660.[doi:10.3969/j.issn.1671-6353.2019.08.009]
[3]阿扎玛提·阿扎提,张国明,阿曼吐尔·介恩什,等.肺细粒棘球蚴破裂与其临床症状及术后并发症的关联性研究[J].临床小儿外科杂志,2023,22(05):465.[doi:10.3760/cma.j.cn101785-202202001-012]
Azamat·Azat,Zhang Guoming,Amantuer·Jieenshen,et al.Clinical symptoms and postoperative complications in ruptured and complete hydatid groups:a comparative study[J].Journal of Clinical Pediatric Surgery,2023,22(12):465.[doi:10.3760/cma.j.cn101785-202202001-012]
[4]王焕民.重视安全与历练,提高小儿肝胆肿瘤诊治水平[J].临床小儿外科杂志,2023,22(12):1101.[doi:10.3760/cma.j.cn101785-202310061-001]
Wang Huanmin.Further improving the diagnoses and treatments of pediatric hepatobiliary tumors[J].Journal of Clinical Pediatric Surgery,2023,22(12):1101.[doi:10.3760/cma.j.cn101785-202310061-001]
[5]唐湘莲,刘登辉,李勇.儿童肝母细胞瘤治疗难点与思考[J].临床小儿外科杂志,2023,22(12):1104.[doi:10.3760/cma.j.cn101785-202310045-002]
Tang Xianglian,Liu Denghui,Li Yong.Difficulties and reflections on proper treatments of hepatoblastoma in children[J].Journal of Clinical Pediatric Surgery,2023,22(12):1104.[doi:10.3760/cma.j.cn101785-202310045-002]
[6]徐晓钢,曾纪晓,罗媛圆,等.全球首例不阻断第一肝门的机器人肝切除术治疗儿童肝母细胞瘤[J].临床小儿外科杂志,2023,22(12):1114.[doi:10.3760/cma.j.cn101785-202307016-004]
Xu Xiaogang,Zeng Jixiao,Luo Yuanyuan,et al.Robotic hepatectomy in a 14-month-old child of hepatoblastoma without the first hepatic portal control:a first case report in the world[J].Journal of Clinical Pediatric Surgery,2023,22(12):1114.[doi:10.3760/cma.j.cn101785-202307016-004]
[7]刘百慧,解鲁璐,姚伟,等.联合肝脏离断和门静脉结扎二步肝切除术治疗儿童巨大肝母细胞瘤[J].临床小儿外科杂志,2023,22(12):1119.[doi:10.3760/cma.j.cn101785-202309028-005]
Liu Baihui,Xie Lulu,Yao Wei,et al.Application of associating liver partition and portal vein ligation during two-stage hepatectomy for massive hepatoblastoma[J].Journal of Clinical Pediatric Surgery,2023,22(12):1119.[doi:10.3760/cma.j.cn101785-202309028-005]
[8]杨丽媛,顾松,王晶,等.m6A修饰在肝母细胞瘤中的研究进展[J].临床小儿外科杂志,2023,22(12):1130.[doi:10.3760/cma.j.cn101785-202209040-007]
Yang Liyuan,Gu Song,Wang Jing,et al.Research advances of m6A modification in hepatoblastoma[J].Journal of Clinical Pediatric Surgery,2023,22(12):1130.[doi:10.3760/cma.j.cn101785-202209040-007]
[9]周恩卿,董瑞.黄连素在儿童胚胎源性肿瘤中的研究进展[J].临床小儿外科杂志,2023,22(12):1135.[doi:10.3760/cma.j.cn101785-202208042-008]
Zhou Enqing,Dong Rui.Research advances of berberine in pediatric embryonal tumors[J].Journal of Clinical Pediatric Surgery,2023,22(12):1135.[doi:10.3760/cma.j.cn101785-202208042-008]
[10]杨维,刘珊,任清华,等.多灶性肝母细胞瘤手术切除的单中心研究[J].临床小儿外科杂志,2024,(06):543.[doi:10.3760/cma.j.cn101785-202310006-007]
Yang Wei,Liu Shan,Ren Qinghua,et al.Hepatectomy for multifocal hepatoblastoma:a single-center report[J].Journal of Clinical Pediatric Surgery,2024,(12):543.[doi:10.3760/cma.j.cn101785-202310006-007]
备注/Memo
收稿日期:2023-10-9。
基金项目:国家自然科学基金重大项目(82293665)
通讯作者:阴捷,Email:yinjie1015@126.com