Okada A, Fukuzawa M, Oue T, Kohmoto Y, Kusafuka T, Fukui Y, Kamata S, Imura K
The Department of Pediatric Surgery, Osaka University Medical School, Suita, Japan.
Eur J Pediatr Surg. 1998 Feb;8(1):17-22. doi: 10.1055/s-2008-1071112.
A description is given of therapeutic experiences with 39 cases of malignant liver tumors in infancy and childhood during the past 38 years. Of these patients, 9 not undergoing hepatic resection all died, while 18 (60%) of 30 patients treated by hepatic resection survived. When only patients with hepatoblastoma are considered, 14 of 24 patients are alive, although 3 of them had local recurrence and had lung metastasis. Among patients with other types of liver tumor, those with hepatocellular carcinomas (2 cases) and vascular neoplasms all died in a short period of time, whereas 2 with yolk sac tumor and one with metabolic pancreatic tumor are alive despite of tumor recurrence. In summary, the results of surgical treatment of malignant liver tumors in infancy and childhood, which formerly were poor, have been improved remarkably, which we owe mainly to: 1) advances in diagnostic imaging techniques (e.g., angiography, ultrasonography, CT and MRI) permitting early diagnosis, localization of tumor, visualization of the coursing of major vessels (particularly, hepatic artery & vein) and more accurate definition of resectability, 2) technical improvement of hepatic resection and 3) progress of chemotherapy mainly with cisplatin and adriamycin.
本文描述了过去38年中39例婴幼儿及儿童期恶性肝肿瘤的治疗经验。这些患者中，9例未接受肝切除，全部死亡；而30例接受肝切除的患者中有18例（60%）存活。仅考虑肝母细胞瘤患者时，24例中有14例存活，尽管其中3例有局部复发和肺转移。在其他类型肝肿瘤患者中，肝细胞癌（2例）和血管肿瘤患者均在短期内死亡，而2例卵黄囊瘤患者和1例代谢性胰腺肿瘤患者尽管肿瘤复发仍存活。总之，婴幼儿及儿童期恶性肝肿瘤的外科治疗结果，此前较差，现已显著改善，这主要归功于：1）诊断成像技术的进步（如血管造影、超声、CT和MRI），可实现早期诊断、肿瘤定位、主要血管（特别是肝动脉和静脉）走行的可视化以及更准确的可切除性定义；2）肝切除技术的改进；3）主要以顺铂和阿霉素为主的化疗进展。
