经导管动脉栓塞术治疗肝母细胞瘤破裂的初步探索.

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. [ABSTRACT FROM AUTHOR]

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 FROM AUTHOR]