儿童肝脏肿瘤(2)
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手术切除对于儿童肝脏肿瘤治疗而言是至关重要的。手术医师必须根据影像学资料推断手术完整切除肿瘤的可行性,术中必须将肿瘤临近淋巴结一并送检病理。如果已经出现肺小结节性转移灶,肝脏原发灶手术切除也应该择期进行,这能改善预后。近年来出现的PET-CT[17]及AFP抗体成像[18]不仅能为外科手术提供肿瘤的精确定位,也能早期提示肿瘤的复发与转移。良性肿瘤及1期肝母细胞瘤能通过一期手术切除获得治愈。由于初始肿瘤体积大,累及肝段多,超过60%的患儿不能一期切除肿瘤,需要接受术前新辅助化疗。常用的化疗药物包括顺铂,长春新碱,5-FU,吡柔比星。如果化疗后患儿AFP下降迅速,肿瘤体积明显缩小,提示预后较好。有25%~30%不能一期切除的患儿疗效不佳,新辅助化疗后仍无法切除肿瘤,原位肝移植为这些患儿带来新希望。近年来活体肝移植成为儿童肝脏恶性肿瘤的治疗新选择。由于正常肝脏对射线耐受剂量小,故而放疗不作为儿童肝脏恶性肿瘤的常规治疗方法。
参考文献
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