發(fā)布時(shí)間：2018-03-09 07:49

  本文選題：肝母細(xì)胞瘤　切入點(diǎn)：治療　出處：《重慶醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的分析不同方式治療小兒HB療效差異,探討小兒HB治療方案。方法(1)回顧分析重慶醫(yī)科大學(xué)附屬兒童醫(yī)院2005年07月-2015年12月收治的HB患兒的臨床資料,病例納入標(biāo)準(zhǔn)為術(shù)前病理診斷或術(shù)后病理檢查結(jié)果符合HB,診斷明確后行HIFU治療或手術(shù)治療,患兒術(shù)前血常規(guī)、凝血象、肝腎功均正常且無器官功能障礙,家屬對于治療方案知情同意并長期隨訪,共計(jì)109例。全部病例按照PRETEXT分期標(biāo)準(zhǔn)進(jìn)行分期,按照SIOPEL危險(xiǎn)度分組標(biāo)準(zhǔn)進(jìn)行分組。(2)完成治療的PRETEXT分期III-IV期病例,按治療方式分為化療后HIFU組、化療后開放手術(shù)組及直接開放手術(shù)組。(3)分析不同治療方式術(shù)后1月、2月血清AFP水平是否降至正常,化療后HIFU組與化療后開放手術(shù)組對比,化療后開放手術(shù)組與直接開放手術(shù)組對比。(4)通過門診或電話方式隨訪完成治療的病例,隨訪時(shí)間從首診時(shí)間開始,截止至2016年02月或患兒死亡時(shí)間,失訪病例截止至失訪時(shí)間。(5)以SPSS 20.0軟件進(jìn)行統(tǒng)計(jì)分析,差異性檢驗(yàn)采用卡方檢驗(yàn),若數(shù)據(jù)不滿足卡方檢驗(yàn)條件,則采用Fisher精確檢驗(yàn),取p0.05為差異有統(tǒng)計(jì)學(xué)意義,否則為差異無統(tǒng)計(jì)學(xué)意義。采用直接法與壽命表法計(jì)算總體生存率與不同治療方式治療后生存率。結(jié)果(1)109例hb患兒中,男性患兒75例,女性患兒34例,男女比例約為2.2:1,患兒年齡最小者為0月24天,年齡最大者為12歲11月,中位年齡1歲3月。全部病例中pretexti期3例,pretextii期6例,除外2例未完成治療,其余均行一期手術(shù)切除輔以術(shù)后化療治療;pretextiii期43例,其中化療后hifu治療6例,化療后開放手術(shù)治療19例,直接開放手術(shù)治療8例,未完成治療10例;pretextiv期57例,其中化療后hifu治療7例,化療后開放手術(shù)治療18例,直接開放手術(shù)治療4例,未完成治療28例。危險(xiǎn)度分組標(biāo)危組47例,高危組62例。(2)本組病例中,化療后hifu治療13例,化療后開放手術(shù)治療37例,直接開放手術(shù)治療19例,未完成治療40例,其中診斷后中斷治療18例,化療后未手術(shù)中斷治療22例。完成治療的62例iii-iv期hb患兒中,化療后hifu組13例,化療后開放手術(shù)組37例,直接開放手術(shù)組12例。(3)術(shù)后血清afp下降情況比較,化療后hifu組與化療后開放手術(shù)組術(shù)后1月時(shí)差異無統(tǒng)計(jì)學(xué)意義(p=0.719,p0.05),術(shù)后2月時(shí)差異無統(tǒng)計(jì)學(xué)意義(p=0.077,p0.05);化療后開放手術(shù)組與直接開放手術(shù)組,術(shù)后1月時(shí)差異無統(tǒng)計(jì)學(xué)意義(p=0.285,p0.05),術(shù)后2月差異無統(tǒng)計(jì)學(xué)意義(p=0.674,p0.05)。(4)隨訪時(shí)間1月至9年零4月,中位隨訪時(shí)間27月。完成治療的病例中,存活53例,死亡11例,失訪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),壽命表法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期患兒均完成治療,截至隨訪時(shí)間全部存活,生存率100%。(5)化療后hifu組存活11例,死亡2例,失訪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),壽命表法1年生存率92.1%,2年生存率83.3%,3年生存率83.3%;化療后開放手術(shù)組存活28例,死亡6例,失訪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),壽命表法1年生存率92.0%,2年生存率75.5%,3年生存率64.1%;直接開放手術(shù)組存活7例,死亡3例,失訪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),壽命表法1年生存率91.4%,2年生存率72.7%,3年生存率56.7%。(6)術(shù)后生存情況對比,化療后hifu組與化療后開放手術(shù)組1年、2年、3年差異均無統(tǒng)計(jì)學(xué)意義(p=0.722、0.261、0.091,p0.05);化療后開放手術(shù)組與直接開放手術(shù)組1年、2年、3年差異均無統(tǒng)計(jì)學(xué)意義(p=0.747、0.572、0.627,p0.05)。結(jié)論(1)小兒hb多見于男性患兒,發(fā)病年齡多為3歲以前,經(jīng)規(guī)范治療后總體預(yù)后尚可,總體5年生存率可達(dá)70%,首診時(shí)間2年內(nèi)為hb患兒死亡的高發(fā)期。(2)pretext分期iii-iv期的hb患兒術(shù)后1月、2月血清afp下降情況,不同治療方式比較均無明顯差異,所以不能直接通過術(shù)后1月、2月血清afp下降情況判斷療效。(3)對于pretext分期iii-iv期hb患兒,化療后hifu治療和化療后開放手術(shù)治療都是較為可靠的治療方式,新輔助化療能在一定程度上改善患兒預(yù)后。不同治療方式術(shù)后生存率差異無統(tǒng)計(jì)學(xué)意義。臨床應(yīng)權(quán)衡利弊,根據(jù)患兒情況制定個(gè)體化治療方案。
[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 鎵嬫湳緇，

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