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肝胚细胞瘤是一种最常见的儿童肝恶性肿瘤。其长久存活取决于肿瘤是否能完全切除。在有效的化疗问世前,仅约25%的患儿可存活。自从采用辅助化疗后,存活率则有改善。近年来对无法切除的肝胚细胞瘤,多采用阿霉素加顺珀作为标准的术前多疗程化疗,1988年所有肝胚细胞瘤病人均采用此疗法。本文报道从1986年至1990年共15例儿童肝胚细胞瘤采用上述标准术前化疗。11例男孩,4例女孩,年龄1个月至10岁。每例均经超声波和 CT 证实有腹部包块。诊断时发现有两肺叶转移,或门静脉和下腔静脉受累,故无法完整切除肿瘤。术前常规测定血清甲胎蛋白。化疗前在局麻和全麻下行经皮穿刺(?)检,以作组织学诊断。每3周进行一个疗程化疗,顺珀(20 mg/m~2/天×5天)、阿霉素(25 mg/m~2/天×3天),静脉内持续滴入。每例病人术前少则3个疗程、多则6个疗程,根据肿瘤是否缩小而定.3个疗程后,若肿块缩小至可切除的范围内则行手术切除术。若第三个疗程后肿块未缩小至上述标准,则继续进行化疗,直至获得必要的疗效或完成6个疗程为止。
Hepatoblastoma is the most common childhood liver malignancy. Its long-term survival depends on whether the tumor can be completely removed. Before the advent of effective chemotherapy, only about 25% of children survived. Since adjuvant chemotherapy was used, the survival rate improved. In recent years, unresectable hepatoblastomas are often treated with doxorubicin plus cisplatin as a standard preoperative multi-course chemotherapy. In 1988, all hepatoblastoma patients were treated with this therapy. This article reports 15 cases of childhood hepatoblastoma from 1986 to 1990 using the standard preoperative chemotherapy. 11 boys and 4 girls, aged 1 month to 10 years old. Each case was confirmed by ultrasound and CT to have abdominal mass. At the time of diagnosis, it was found that there were metastases in both lobes, or portal vein and inferior vena cava, so it was impossible to completely remove the tumor. Preoperative routine determination of serum alpha-fetoprotein. Before chemotherapy, percutaneous puncture (?) was performed under local anesthesia and general anesthesia for histological diagnosis. A course of chemotherapy was performed every 3 weeks, Shunpo (20 mg/m~2/day×5 days), Doxorubicin (25 mg/m~2/day×3 days), and continuous intravenous infusion. Each patient had at least three courses of treatment and as many as six courses of treatment, depending on whether the tumor was reduced. After three courses of treatment, surgical resection was performed if the tumor was reduced to a resectable range. If the mass is not reduced to the above criteria after the third course of treatment, chemotherapy is continued until the necessary efficacy is achieved or 6 courses are completed.