经导管动脉化疗栓塞治疗小儿肝母细胞瘤的疗效分析

Therapeutic effect of hepatic arterial chemoembolization on hepatoblastoma in children

摘要:

目的 探讨经导管动脉化疗栓塞（TACE）治疗小儿肝母细胞瘤的临床疗效。方法 选取2018年5月—2021年5月上海儿童医学中心三亚市妇女儿童医院收治的106例肝母细胞瘤患儿，采用随机数字表法将患儿分为观察组和对照组，每组53例，分别给予TACE联合手术治疗和单纯手术治疗。采用全自动生化分析仪检测血生化指标（ALT、AST），采用酶联免疫吸附试验（ELISA）检测创伤应激指标［皮质醇（Cor）、促肾上腺皮质激素（ACTH）、血管紧张素Ⅱ（AngⅡ）］及血清炎症因子［降钙素原（PCT）、C反应蛋白（CRP）］。结果 观察组手术时间短于对照组（P <0.05），术中出血量少于对照组（P <0.05），切除肝脏组织重量小于对照组（P <0.05）。两组术前、术后3 d、术后7 d的血清ALT和AST水平比较：①不同时间点的血清ALT和AST水平有差异（P <0.05）；②两组的血清ALT和AST水平有差异（P <0.05）；③两组的血清ALT和AST水平变化趋势有差异（P <0.05）。两组术前、术后3 d、术后7 d的Cor、ACTH、AngⅡ水平比较：①不同时间点的Cor、ACTH、AngⅡ水平有差异（P <0.05）；②两组的Cor、ACTH、AngⅡ水平有差异（P <0.05）；③两组的Cor、ACTH、AngⅡ水平变化趋势有差异（P <0.05）。两组术前、术后3 d、术后7 d的PCT、CRP水平比较：①不同时间点的PCT、CRP水平有差异（P <0.05）；②两组的PCT、CRP水平有差异（P <0.05）；③两组的PCT、CRP水平变化趋势有差异（P <0.05）。两组并发症总发生率比较，差异无统计学意义（P >0.05）。结论 相较于单纯手术治疗，TACE联合手术治疗对肝母细胞瘤患儿造成的应激反应和炎症反应较轻，且对肝功能的影响较小，可缩短手术时间，减少术中出血量，且不增加手术并发症发生率，值得临床应用。

Abstract:

Objective To investigate the clinical effect of hepatic arterial chemoembolization (TACE) in the treatment of pediatric hepatoblastoma (HB).Methods One hundred and six children with HB were admitted to our hospital between May 2018 and May 2021. The selected children were randomly divided into 53 cases in the control group and 53 cases in the observation group, and operation or TACE combined operation were performed separately. The blood biochemical indexes were detected by automatic biochemical analyzer, and the levels of serum procalcitonin (PCT), C-reactive protein (CRP), cortisol (COR), adrenocorticotropic hormone (ACTH), and angiotensin-Ⅱ (Ang Ⅱ) were detected by ELISA.Results The operation time of the observation group was shorter than that of the control group (P < 0.05), and the amount of blood loss and weight of removed liver tissue were lower than that of the control group (P < 0.05). Comparison of blood biochemical indexes between the observation group and the control group before operation, 3 d, and 7d after operation, ANOVA with repeated measurement design was adopted, and the results were as follows: Serum ALT and AST levels were significantly different at different time points before and after operation (P < 0.05); There were differences in serum ALT and AST levels between the observation group and the control group at different postoperative time points (P < 0.05), the serum ALT and AST levels in the observation group were lower than those in the control group at different postoperative time points, and the effect on liver function was relatively small; The serum ALT and AST levels of the observation group and the control group were different (P < 0.05). Comparison of traumatic stress index levels between the observation group and the control group at different time points before operation, 3 d, and 7d after operation, ANOVA designed by repeated measurement was adopted, and the results were as follows: The levels of traumatic stress indexes were different at different time points before and after surgery (P < 0.05); The levels of traumatic stress indexes were different between the observation group and the control group at different postoperative time points (P < 0.05), the serum levels of Cor, ACTH, and AngⅡ in the observation group were lower than those in the control group at 3 and 7 days after operation, and the relative stress response was smaller; There was a difference in the trend of traumatic stress index between the observation group and the control group (P < 0.05). Comparison of serum inflammatory factor levels between the observation group and the control group at different time points before operation, 3 d, and 7d after operation, ANOVA with repeated measurement design was adopted, and the results were as follows: The levels of serum inflammatory factors were different at different time points before and after operation (P < 0.05); The levels of serum inflammatory factors were different between the observation group and the control group at different postoperative time points (P < 0.05), the serum levels of PCT and CRP in the observation group were lower than those in the control group at 3 and 7 days after operation, and the inflammatory response was relatively small; There was a difference in the trend of serum inflammatory factors between the observation group and the control group (P < 0.05). During treatment, there was no significant difference in the total incidence of complications between the two groups (P < 0.05).Conclusion Compared with surgical treatment alone, TACE combined with surgical treatment causes less stress response and inflammatory response in HB children, and had less impact on liver function, which could reduce the operation time and blood loss without increasing the incidence of surgical complications, which is worthy of clinical verification.