Finegold Milton J, Egler Rachel A, Goss John A, Guillerman R Paul, Karpen Saul J, Krishnamurthy Rajesh, O'Mahony Christine Ann
Baylor College of Medicine, Houston, TX, USA.
Liver Transpl. 2008 Nov;14(11):1545-56. doi: 10.1002/lt.21654.
Liver tumors in childhood are rare and are typically not detected clinically until they reach a large size and often spread within the organ or metastasize. This can make surgical resection problematic, and almost all of them require extirpation for cure. With very effective chemotherapy for hepatoblastoma and to some extent for sarcomas, many cancers can be shrunk to permit partial hepatectomy, but for most hepatocarcinomas, some of the other malignancies, and even some benign proliferations, their location at the hilum and multiplicity of masses in multiple lobes make transplantation the treatment of choice. Major advances in diagnostic imaging, especially enhanced computed tomography and magnetic resonance imaging, permit a preoperative choice of resection versus transplantation to be achieved in almost all instances, and for the remainder, intraoperative ultrasonography can further help to determine the most desirable approach. The outcome is very much better in the case of hepatoblastoma when transplantation is a primary modality rather than following unsuccessful attempts at resection. In this review, transplantation for liver tumors in children is considered from all aspects, including the importance of screening for tumors whenever possible to avoid the need for transplantation.
儿童肝肿瘤较为罕见，临床上通常在肿瘤长得很大、常在肝内播散或发生转移时才被发现。这会使手术切除存在问题，几乎所有此类肿瘤都需要切除才能治愈。由于针对肝母细胞瘤以及在一定程度上针对肉瘤有非常有效的化疗方法，许多癌症可缩小以便进行部分肝切除术，但对于大多数肝癌、一些其他恶性肿瘤，甚至一些良性增生性病变而言，其位于肝门处以及多叶内肿块的多发性使得肝移植成为首选治疗方法。诊断性影像学的重大进展，尤其是增强计算机断层扫描和磁共振成像，几乎在所有情况下都能实现术前对切除还是移植的选择，而对于其余情况，术中超声检查可进一步帮助确定最理想的治疗方法。当肝移植作为主要治疗方式而非在切除尝试失败后进行时，肝母细胞瘤的治疗效果要好得多。在本综述中，从各个方面对儿童肝肿瘤的肝移植进行了探讨，包括尽可能进行肿瘤筛查以避免肝移植需求的重要性。
