手术联合腹腔热灌注化疗治疗儿童肝细胞癌破裂出血1 例 报告并文献复习
| 作者: |
1彭沙勇,
1彭创,
1钟振东,
1刘鑫宇,
1易为民,
1谭朝霞
1 湖南师范大学附属第一医院/ 湖南省人民医院 肝胆外科，湖南 长沙410005 |
| 通讯: |
彭创
Email: pengchuang@163.com |
| DOI: | 10.3978/.2018.07.009 |
| 基金: | 中国博士后科学基金资助项目（2017M620347）；湖南省科技厅科技计划资助项目项目（2015SK2050）；湖南省教育厅科学研究资助项目（17C0963）。 |
摘要
目的：探讨腹腔热灌注化疗（HIPEC）治疗儿童肝细胞癌自发破裂出血的安全性及可行性。
方法：回顾性分析 1 例手术切除后联合腹腔热灌注化疗治疗儿童肝细胞癌破裂出血患者的临床与随访资料，并复习相关文献。
结果：患儿，男，10 岁，因肝内肿块破裂于外院行急诊介入栓塞止血治疗，6 d 后于湖南省人民医院肝胆外科接受胆囊切除 + 左半肝切除 + HIPEC（5% 葡萄糖溶液 3 000 mL+ 吡柔比星 10 mg，41 ℃循环灌注 40 min），手术顺利，围手术期未出现并发症。术后病理结果证实为肝细胞肝癌 III 级及 R0 切缘。患儿随后转儿童血液肿瘤科，以 FOLFOX4 方案化疗。术后 11 个月复查示，甲胎蛋白 9.56 ng/mL， HBV-DNA<100 IU/mL，上腹部 MRI 未见肿瘤复发。
结论：手术联合 HIPEC 治疗儿童肝细胞癌破裂出血是安全可行，近期效果满意。
关键词：
癌，肝细胞；破裂，自发性；肝切除术；化学疗法，肿瘤，局部灌注；儿童
方法：回顾性分析 1 例手术切除后联合腹腔热灌注化疗治疗儿童肝细胞癌破裂出血患者的临床与随访资料，并复习相关文献。
结果：患儿，男，10 岁，因肝内肿块破裂于外院行急诊介入栓塞止血治疗，6 d 后于湖南省人民医院肝胆外科接受胆囊切除 + 左半肝切除 + HIPEC（5% 葡萄糖溶液 3 000 mL+ 吡柔比星 10 mg，41 ℃循环灌注 40 min），手术顺利，围手术期未出现并发症。术后病理结果证实为肝细胞肝癌 III 级及 R0 切缘。患儿随后转儿童血液肿瘤科，以 FOLFOX4 方案化疗。术后 11 个月复查示，甲胎蛋白 9.56 ng/mL， HBV-DNA<100 IU/mL，上腹部 MRI 未见肿瘤复发。
结论：手术联合 HIPEC 治疗儿童肝细胞癌破裂出血是安全可行，近期效果满意。
Surgical resection combined with hyperthermic intraperitoneal chemoperfusion for spontaneous rupture/hemorrhage of hepatocellular carcinoma in children: a report of one case and literature review
CorrespondingAuthor:Chuang PENG Email: pengchuang@163.com
Abstract
Objective: To investigate the safety and feasibility of hyperthermic intraperitoneal chemoperfusion (HIPEC) in treatment of spontaneous rupture/hemorrhage of hepatocellular carcinoma in children.
Methods: The clinical and follow-up data of one pediatric patient with spontaneous rupture/hemorrhage of hepatocellular carcinoma were retrospectively analyzed and the relevant literature was reviewed.
Results: The 10-year old female patient underwent emergency interventional embolization therapy for hemostasis due to rupture of intrahepatic tumor in other hospital, and received cholecystectomy and hemihepatectomy combined with HIPEC (10 mg pirarubicin diluted in 3 000 mL 5% glucose, circulated for 40 min at 41 °C) 6 days later in the Department of Hepatobiliary Surgery of Hunan Provincial People’s Hospital. The operation was uneventfully performed and no complications occurred during the perioperative period. The postoperative pathology confirmed a grade III hepatocellular carcinoma with R0 resection margin. Subsequently, the patient was transferred to the Department of Pediatric Hematological Oncology and received chemotherapy using a FOLFOX4 regimen. Follow-up examinations at 11 months after operation showed that the AFP was 9.56 ng/mL, the HBV-DNA was under 100 IU/mL, and no tumor recurrence occurred as evidenced by upper abdominal MRI.
Conclusion: Surgical resection combined with HIPEC is safe and feasible for the treatment of spontaneous rupture/hemorrhage of hepatocellular carcinoma in children, with satisfactory short-term results.
Keywords：
Carcinoma
Hepatocellular; Rupture
Spontaneous; Hepatectomy; Chemotherapy
Cancer
Regional Perfusion; Child
Methods: The clinical and follow-up data of one pediatric patient with spontaneous rupture/hemorrhage of hepatocellular carcinoma were retrospectively analyzed and the relevant literature was reviewed.
Results: The 10-year old female patient underwent emergency interventional embolization therapy for hemostasis due to rupture of intrahepatic tumor in other hospital, and received cholecystectomy and hemihepatectomy combined with HIPEC (10 mg pirarubicin diluted in 3 000 mL 5% glucose, circulated for 40 min at 41 °C) 6 days later in the Department of Hepatobiliary Surgery of Hunan Provincial People’s Hospital. The operation was uneventfully performed and no complications occurred during the perioperative period. The postoperative pathology confirmed a grade III hepatocellular carcinoma with R0 resection margin. Subsequently, the patient was transferred to the Department of Pediatric Hematological Oncology and received chemotherapy using a FOLFOX4 regimen. Follow-up examinations at 11 months after operation showed that the AFP was 9.56 ng/mL, the HBV-DNA was under 100 IU/mL, and no tumor recurrence occurred as evidenced by upper abdominal MRI.
Conclusion: Surgical resection combined with HIPEC is safe and feasible for the treatment of spontaneous rupture/hemorrhage of hepatocellular carcinoma in children, with satisfactory short-term results.