%0 Journal Article
%T 行根治性切除术的儿童肝母细胞瘤54例预后因素分析
%A 吴琳琳
%A 　禚孝颖
%A 　刘洁
%A 　沈刚　赵洁　郝希伟　段于河　姜帅　夏楠　魏宾　董蒨
%J -
%D 2020
%R 10.13362/j.jpmed.202002011
%X 摘要 目的　探讨行根治性切除术的儿童肝母细胞瘤（HB）预后影响因素。 方法　选取2002年1月－2019年6月于我院小儿外科因HB行根治性切除术的患儿临床及随访资料，进行临床疗效及预后分析。 结果　手术切缘＜1 cm患儿的总体生存率与手术切缘≥1 cm患儿相比差异无显著性（P＞0.05）。初诊年龄≥54个月的患儿的总体生存率明显低于年龄＜54个月患儿（χ2=4.006,P＜0.05）。血清甲胎蛋白水平＜100 μg/L患儿总体生存率低于血清甲胎蛋白水平≥100 μg/L的患儿（χ2=10.005，P＜0.05）。肿瘤侵犯肝内一级分支血管患儿预后差于未侵犯肝内一级血管的患儿，并且存在肝外转移的患儿预后差于无肝外转移的患儿（χ2=8.588、12.581，P＜0.05）。Hisense CAS系统三维重建组患儿中位手术时间和术后住院时间较无三维重建组的患儿更短，并且术中出血量更少（P＜0.05）。 结论　行根治性切除术的HB患儿预后与患儿年龄、血清甲胎蛋白水平、有无血管侵犯及有无肝外转移有密切关系，手术边界＜1 cm不是影响HB患儿预后及远期生存的因素。Hisense CAS系统可有效缩短HB患儿手术治疗时间，减少术中出血量，并缩短术后住院时间。<br>Abstract：Objective　To investigate the influencing factors for the prognosis of children with hepatoblastoma (HB) undergoing radical resection. Methods　A retrospective analysis was performed for the clinical and follow-up data of children who underwent radical resection for HB in Department of Pediatric Surgery in our hospital from January 2002 to June 2019, and their clinical outcomes and prognosis were analyzed. Results　There was no significant difference in overall survival rate between the children with a resection margin of<1 cm and those with a resection margin of ≥1 cm (P>0.05). The children with an age of ≥54 months at initial diagnosis had a significantly lower overall survival rate than those with an age of<54 months (χ2=4.006,P<0.05), and the children with a serum alpha-fetoprotein (AFP) level of<100 μg/L had a significantly lower overall survival rate than those with a serum AFP level of ≥100 μg/L (χ2=10.005,P<0.05). The children with tumors invading the primary intrahepatic vessels had worse prognosis than those with tumors not invading such vessels, and the children with extrahepatic metastasis had worse prognosis than those without extrahepatic metastasis (χ2=8.588,12.581,P<0.05). The children who underwent Hisense CAS 3D reconstruction had significantly shorter median time of operation and length of postoperative hospital stay and significantly lower intraoperative blood loss than those who did not undergo 3D reconstruction (P<0.05). Conclusion　The prognosis of children with HB undergoing radical resection is closely associated with age, serum AFP level, presence or absence of vascular invasion, and presence or absence of extrahepatic metastasis, and a resection margin of <1 cm is not an influencing factor for prognosis and long-term survival. Hisense CAS system can effectively shorten the time of operation, reduce intraoperative blood loss, and shorten the length of postoperative hospital stay in children with HB
%K 肝胚细胞瘤
%K 肝切除术
%K 成像
%K 三维
%K 外科手术
%K 计算机辅助
%K 甲胎蛋白类
%K 预后
%K 精准医学
%K Hisense CAS
%K 儿童<br>Hepatoblastoma
%K Hepatectomy
%K Imaging
%K three-dimensional
%K Surgery
%K computer-assisted
%K alpha-Fetoproteins
%K Prognosis
%K Precision medicine
%K Hisense CAS
%K Child
%U http://jpmed.qdu.edu.cn/CN/10.13362/j.jpmed.202002011