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題名 | Hepatoblastoma in Infancy and Childhood: A Clinical and Pathological Study of 32 Cases=嬰幼兒肝芽細胞瘤: 32例臨床及病理學研究 |
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作者姓名(中文) | 郭啟昱; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷期 | 32:2 民80.03-04 |
頁次 | 頁79-87 |
分類號 | 417.5012 |
關鍵詞 | 嬰幼兒; 肝芽細胞瘤; 病理學研究; |
語文 | 英文(English) |
中文摘要 | 肝芽細胞瘤是嬰幼兒最常見的肝臟惡性腫瘤,台大醫院小兒科從1959年6月到1988年10月的29年間,總共有32個病理的切片診斷為肝芽細胞瘤的病例,診斷時的年齡為4天大到6歲大,平均年齡為1歲到8個月,大部份(87.5%)是小於3歲。有16例是男性,16例是女性,沒有性別上的差異。臨床上最常見的症狀是上腹部腫瘤(71.9%)及/或腹脹(62.5%)。理學檢查,全部有肝腫大,有的可摸到腫瘤。不正常的實驗室檢查結果,主要包括血小板增生(64.3%),血清轉胺酶AST升高(75.0%),ALT升高(62.5%),膽固醇升高(78.3%)及α-胎兒蛋白的增加(92.3%)。有10例接受腹部超音波檢查,顯示腫瘤較正常肝組織有高的超音波密度,有3例在腫瘤內有較低回音;6例接受腹部電腦斷層掃描,顯示腫瘤是較正常肝組織為低的顯影,注射顯影劑之後亦是如此;4例接受血管攝影,顯示血管被腫瘤撐開,並可見腫瘤染色(Tumor Stains);根據Ishak和Glunz的病理分類,有56.3%的病例是上皮型(Epithelial type),其餘則屬於混合型(Mixed type),在我們追踪至1990年4月間,有6個病人存活,他們都是接受了腫瘤的完全切除,存活期間從2年到17年又4個月(平均存活7年又2個月);有22個病人診斷之後8天到16個月內死亡(平均存活3個月),他們分別接受了內科治療或不完全切除手術或被認為完全切除的手術;有4個病人失去追踪;兩年的存活率為21.4%。接受完全切除手術的病人預後較好,另外治療前的血清膽固醇的高低也可當做預後的指標,膽固醇高的病例預後較差。 |
英文摘要 | During the twenty-nine-year period from June 1959 to October 1988, 32 infants and children with histology-proved hepatoblastoma were seen at the Department of Pediatrics, National Taiwan University Hospital (NTUH). The age at diagnosis ranged from four days to six years, with a mean of one year and eight months. Most of the patients (87.5%) were under the age of three. There was no sex predilection (16 males, 16 females). The most common presenting signs were an upper abdominal mass (71.9%) and/or abdominal distention (62.5%). Physically, all the patients revealed hepatomegaly, with or without mass. Laboratory abnormalities included primarily thrombocytosis (64.3%), elevated serum aspartate aminotransferase (75.0%), serum alanine aminotransferase (62.5%), cholesterol (78.3%) and alphafetoprotein (92.3%). According to the classification of Ishak and Glunz, 56.3% of these belonged to the epithelial type; the others belonged to the mixed type. During the follow-up period, 6 patients with complete resection of the tumor remained alive from 2 years to 17 years and 4 months. Twenty-two patients died from 8 days to 16 months after diagnosis. Four patients were lost to follow-up. The two-year survival rate was 21.4% (6/28). Complete resection of the tumor was the key treatment for achieving survival. |
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