Ohtsuka Yasuhiro, Matsunaga Tadashi, Yoshida Hideo, Kouchi Katsunori, Okada Tadao, Ohnuma Naomi
Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuou-ku, Chiba 260-8677, Japan.
Surg Today. 2004;34(2):127-33. doi: 10.1007/s00595-003-2663-7.
To investigate the optimal strategy of preoperative transcatheter arterial chemoembolization (TACE) for hepatoblastoma.
Between 1992 and 2001, 7 children with hepatoblastoma (aged 9 months to 13 years) underwent preoperative TACE. The chemoembolic agent used was an emulsion of pirarubicin and lipiodol. Four patients without distant metastasis underwent "primary" TACE without systemic chemotherapy. The other 3 with distant metastases underwent "delayed" TACE following systemic chemotherapy. These patients were all examined retrospectively using clinical data.
The average dosage of lipiodol was 0.6 ml per tumor maximal diameter (cm). All the primary cases showed a significant decrease in alpha-fetoprotein (AFP) and a reduction in the tumor size. They consequently underwent a complete surgical resection and are now disease free. All the delayed cases showed a slight decrease in AFP and underwent complete surgical resection; however, two of them died of lung metastases, and the other died of a second malignancy. Regarding complications, liver dysfunction and pulmonary embolism occurred in one patient each.
For patients without distant metastasis, regardless of the resectability of the primary tumor, TACE may be considered the initial and only preoperative treatment, and it may be repeated. For patients with distant metastases, their complete eradication with systemic chemotherapy prior to TACE is essential.
探讨肝母细胞瘤术前经导管动脉化疗栓塞（TACE）的最佳策略。
1992年至2001年间，7例肝母细胞瘤患儿（年龄9个月至13岁）接受了术前TACE。所用化疗栓塞剂为吡柔比星与碘油的乳剂。4例无远处转移的患者接受了“原发性”TACE，未进行全身化疗。另外3例有远处转移的患者在全身化疗后接受了“延迟性”TACE。对这些患者均采用临床资料进行回顾性研究。
碘油平均用量为每肿瘤最大直径（cm）0.6 ml。所有原发性病例的甲胎蛋白（AFP）均显著下降，肿瘤大小缩小。因此，他们均接受了完整的手术切除，目前无疾病。所有延迟性病例的AFP均略有下降，并接受了完整的手术切除；然而，其中2例死于肺转移，另1例死于第二原发恶性肿瘤。关于并发症，1例患者出现肝功能障碍，1例出现肺栓塞。
对于无远处转移的患者，无论原发肿瘤是否可切除，TACE可被视为初始且唯一的术前治疗方法，且可重复进行。对于有远处转移的患者，在TACE前用全身化疗彻底根除转移灶至关重要。
