不同方式治疗小儿肝母细胞瘤疗效分析

发布时间：2018-03-09 07:49

  本文选题：肝母细胞瘤　切入点：治疗　出处：《重庆医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的分析不同方式治疗小儿HB疗效差异,探讨小儿HB治疗方案。方法(1)回顾分析重庆医科大学附属儿童医院2005年07月-2015年12月收治的HB患儿的临床资料,病例纳入标准为术前病理诊断或术后病理检查结果符合HB,诊断明确后行HIFU治疗或手术治疗,患儿术前血常规、凝血象、肝肾功均正常且无器官功能障碍,家属对于治疗方案知情同意并长期随访,共计109例。全部病例按照PRETEXT分期标准进行分期,按照SIOPEL危险度分组标准进行分组。(2)完成治疗的PRETEXT分期III-IV期病例,按治疗方式分为化疗后HIFU组、化疗后开放手术组及直接开放手术组。(3)分析不同治疗方式术后1月、2月血清AFP水平是否降至正常,化疗后HIFU组与化疗后开放手术组对比,化疗后开放手术组与直接开放手术组对比。(4)通过门诊或电话方式随访完成治疗的病例,随访时间从首诊时间开始,截止至2016年02月或患儿死亡时间,失访病例截止至失访时间。(5)以SPSS 20.0软件进行统计分析,差异性检验采用卡方检验,若数据不满足卡方检验条件,则采用Fisher精确检验,取p0.05为差异有统计学意义,否则为差异无统计学意义。采用直接法与寿命表法计算总体生存率与不同治疗方式治疗后生存率。结果(1)109例hb患儿中,男性患儿75例,女性患儿34例,男女比例约为2.2:1,患儿年龄最小者为0月24天,年龄最大者为12岁11月,中位年龄1岁3月。全部病例中pretexti期3例,pretextii期6例,除外2例未完成治疗,其余均行一期手术切除辅以术后化疗治疗;pretextiii期43例,其中化疗后hifu治疗6例,化疗后开放手术治疗19例,直接开放手术治疗8例,未完成治疗10例;pretextiv期57例,其中化疗后hifu治疗7例,化疗后开放手术治疗18例,直接开放手术治疗4例,未完成治疗28例。危险度分组标危组47例,高危组62例。(2)本组病例中,化疗后hifu治疗13例,化疗后开放手术治疗37例,直接开放手术治疗19例,未完成治疗40例,其中诊断后中断治疗18例,化疗后未手术中断治疗22例。完成治疗的62例iii-iv期hb患儿中,化疗后hifu组13例,化疗后开放手术组37例,直接开放手术组12例。(3)术后血清afp下降情况比较,化疗后hifu组与化疗后开放手术组术后1月时差异无统计学意义(p=0.719,p0.05),术后2月时差异无统计学意义(p=0.077,p0.05);化疗后开放手术组与直接开放手术组,术后1月时差异无统计学意义(p=0.285,p0.05),术后2月差异无统计学意义(p=0.674,p0.05)。(4)随访时间1月至9年零4月,中位随访时间27月。完成治疗的病例中,存活53例,死亡11例,失访5例,直接法1年生存率92.4%(49/53)、2年生存率74.3%(26/35)、3年生存率62.1%(18/29),寿命表法1年生存率93.0%,2年生存率79.2%,3年生存率72.0%,其中i-ii期患儿均完成治疗,截至随访时间全部存活,生存率100%。(5)化疗后hifu组存活11例,死亡2例,失访0例,直接法1年生存率92.3%(12/13)、2年生存率83.3%(10/12)、3年生存率81.8%(9/11),寿命表法1年生存率92.1%,2年生存率83.3%,3年生存率83.3%;化疗后开放手术组存活28例,死亡6例,失访3例,直接法1年生存率91.7%(22/24)、2年生存率64.3%(9/14)、3年生存率45.4%(5/11),寿命表法1年生存率92.0%,2年生存率75.5%,3年生存率64.1%;直接开放手术组存活7例,死亡3例,失访2例,直接法1年生存率91.7%(11/12)、2年生存率71.4%(5/7)、3年生存率50.0%(3/6),寿命表法1年生存率91.4%,2年生存率72.7%,3年生存率56.7%。(6)术后生存情况对比,化疗后hifu组与化疗后开放手术组1年、2年、3年差异均无统计学意义(p=0.722、0.261、0.091,p0.05);化疗后开放手术组与直接开放手术组1年、2年、3年差异均无统计学意义(p=0.747、0.572、0.627,p0.05)。结论(1)小儿hb多见于男性患儿,发病年龄多为3岁以前,经规范治疗后总体预后尚可,总体5年生存率可达70%,首诊时间2年内为hb患儿死亡的高发期。(2)pretext分期iii-iv期的hb患儿术后1月、2月血清afp下降情况,不同治疗方式比较均无明显差异,所以不能直接通过术后1月、2月血清afp下降情况判断疗效。(3)对于pretext分期iii-iv期hb患儿,化疗后hifu治疗和化疗后开放手术治疗都是较为可靠的治疗方式,新辅助化疗能在一定程度上改善患儿预后。不同治疗方式术后生存率差异无统计学意义。临床应权衡利弊,根据患儿情况制定个体化治疗方案。
[Abstract]:Objective to analyze the curative effect in the treatment of children with HB in different ways to explore differences in the treatment of children with HB (1). Methods Retrospective analysis of clinical data of 2005 children's Hospital Affiliated to Medical University Of Chongqing in December 07 -2015 were treated with HB, the inclusion criteria for the preoperative pathological diagnosis and postoperative pathological examination results with HB, diagnosed by HIFU treatment or surgery the preoperative treatment, blood routine, blood coagulation, liver and kidney function were normal and no organ dysfunction, family therapy for informed consent and long-term follow-up, a total of 109 cases. All cases according to PRETEXT staging, were grouped according to the classification standard of SIOPEL risk. (2) completed the treatment of PRETEXT stage III-IV cases, according to the patients were divided into HIFU group after chemotherapy, chemotherapy after open surgery group and open surgery group directly. (3) analysis of different treatment methods after January February, serum AFP level is reduced To normal, HIFU after chemotherapy group and chemotherapy group compared to open surgery, chemotherapy after open surgery group and open surgery group (4) by contrast. Follow up clinic or telephone to complete the treatment of cases, follow-up time from the time of initial diagnosis, as of 2016 02 months or in the time of death, lost follow-up deadline lost time. (5) using SPSS 20 software for statistical analysis, the difference by chi square test, if the data does not meet the conditions of using the chi square test, Fisher exact test, P0.05 was statistically significant, otherwise no significant difference. The direct method and the life table method in general the survival rate and the different methods of treating the survival rate (1). The results of the 109 HB patients, 75 cases were male, 34 cases were female, male to female ratio is about 2.2:1, with the minimum age for 0 months and 24 days, the maximum age is 12 years old in November, aged 1 In March 3 cases. All cases in stage pretexti, 6 stage pretextii cases, except 2 cases of non completion of treatment, the others underwent a period of treatment of surgery and postoperative chemotherapy; 43 cases of stage pretextiii, the HIFU after chemotherapy treatment in 6 cases, chemotherapy after open surgery in 19 cases, 8 cases of open surgical treatment directly that did not complete the treatment in 10 cases; 57 cases of stage pretextiv, the HIFU after chemotherapy treatment in 7 cases, chemotherapy after open surgery in 18 cases, direct open surgery in 4 cases, did not complete the treatment in 28 cases. Risk grouping standard risk group 47 cases, 62 cases of high-risk group. (2) in this group of cases, 13 patients treated with HIFU chemotherapy, chemotherapy after open surgery in 37 cases, direct open surgery in 19 cases, did not complete the treatment of 40 cases, the diagnosis after the treatment of 18 cases of interruption, surgical treatment of 22 cases without interruption after chemotherapy. 62 cases of stage III-IV with HB treatment, 13 cases of group HIFU after chemotherapy, after chemotherapy 37 cases of open surgery group, directly open 鎵嬫湳缁，

本文编号：1587619