PRETEXT分期系统结合影像学特点在儿童肝母细胞瘤治疗评价中的应用价值研究

发布时间：2018-01-01 10:36

  本文关键词：PRETEXT分期系统结合影像学特点在儿童肝母细胞瘤治疗评价中的应用价值研究　出处：《中国医学计算机成像杂志》2017年04期 　论文类型：期刊论文

  更多相关文章： 肝脏 儿童 肝母细胞瘤 CT PRETEXT分期

【摘要】：目的:对CT肝脏功能分段法及PRETEXT分期系统并结合影像学特点,在儿童肝母细胞瘤(hepatoblastoma,HB)治疗中的有效性进行评价。方法:回顾性分析2012年7月至2016年9月经CT诊断的儿童肝母细胞瘤共36例,分析其临床资料和影像表现,使用CT断层功能分段法及PRETEXT分期对36例肿瘤进行分期,结合影像特点,采用相应的治疗方案进行治疗,对36例病例的治疗效果进行分析。所有病例均经病理证实。结果:36病例:(1)影像特点:平扫期肿块密度较正常肝脏实质稍低,含有钙化的18例,占50%;2例增强后动脉期明显强化,病理为纯胎儿型;3例增强后呈极轻度强化,为小细胞未分化型;31例增强后呈轻度至中度不均匀强化,为上皮混合型14例及上皮间叶混合型17例。(2)CT PRETEXT分期:Ⅰ期5例,Ⅱ期12例,Ⅲ期17例,Ⅳ期2例;根据手术结果再次使用PRETEXT分期法进行分期,Ⅰ期5例,Ⅱ期8例,Ⅲ期22例,Ⅳ期1例,总体准确率为86.1%(31/36)。(3)治疗效果评价:根据PRETEXT分期结合CT表现,Ⅰ期5例和Ⅱ期6/8例直接手术切除;Ⅱ期2/8例由于伴有腹水、肺部转移和门静脉瘤栓,与Ⅲ期22例和Ⅳ期1例先行活检。11/13例直接手术切除病例,2例随访复查无明显复发征象,9例行化疗巩固治疗,无明显异常;25/36例病例经2个化疗期后,均显示瘤体有不同程度的缩小,但所占肝脏的分段不变,随后对肿块进行手术切除。结论:PRETEXT分期系统对肝母细胞瘤治疗方案选择有重要的指导价值,结合肿瘤影像学的特点,对本病进行合理的评估,从而为肿瘤手术时机及化疗方案的调整提供帮助。
[Abstract]:Objective: to study the application of CT and PRETEXT staging system in hepatoblastoma in children with hepatoblastoma. Methods: the clinical data and imaging findings of 36 children with hepatoblastoma diagnosed by CT from July 2012 to 2016 were analyzed retrospectively. Ct tomography and PRETEXT staging were used to staging 36 cases of tumors. According to the imaging features, the corresponding treatment scheme was used. The therapeutic effects of 36 cases were analyzed. All the cases were confirmed by pathology. Results the imaging features of 1 / 36 cases were as follows: mass density in plain scan was slightly lower than that in normal liver, and calcification was found in 18 cases. 50%; In 2 cases, the enhancement of posterior artery phase was obvious, and the pathology was pure fetal type. 3 cases showed very slight enhancement after enhancement, which was small cell undifferentiated type. 31 cases showed mild to moderate heterogeneous enhancement after enhancement, including 14 cases of epithelial mixed type and 17 cases of mixed epithelial lobe type. Ct PRETEXT staging: stage 鈪，

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