Patient's question:
Currently, under normal circumstances: No abnormalities are observed.Doctor's answer:
Hepatoblastoma is a malignant tumor originating from hepatocytes. Due to its rich blood supply and rapid growth rate, children in the early or middle stages may not exhibit obvious clinical symptoms or liver function changes, making it difficult to detect. In this group of cases, early symptoms included abdominal discomfort, anorexia, and occasional low fever. Later, jaundice and an abdominal mass appeared, and diagnosis was confirmed through ultrasound, liver and biliary CT, and AFP testing. Although surgical treatment was performed, the outcome was not ideal. Since hepatoblastoma is a type of embryonal liver cell tumor, elevated AFP levels in the blood are of diagnostic significance (with reported positive rates as high as 66% to 91%). Additionally, when children exhibit symptoms such as weight loss, anemia, anorexia, abdominal distension, or an abdominal mass, these should not be ignored. Ultrasound, CT, and other examinations can aid in diagnosis and differential diagnosis. Early diagnosis and early surgical resection of the lesion can prolong the child's life.Childhood hepatoblastoma is characterized by rapid progression and high malignancy. The primary treatment involves surgical resection of the lesion, supplemented by chemotherapy. The principle of surgery is to completely remove the lesion, control liver bleeding, and prevent postoperative liver function failure. Regarding surgical techniques, liver lobectomy or hemihepatectomy is generally chosen. It is noteworthy that children undergoing surgery require general anesthesia, and efforts should be made to select anesthetics with minimal impact on liver function, such as fentanyl. During surgery, adequate oxygenation must be ensured, along with necessary electrocardiogram monitoring. Regarding the impact of partial liver resection on liver function, reports indicate that liver resection of 50% to 70% does not affect liver function. In this group, four cases underwent multilobectomy and hemihepatectomy, respectively, and none exhibited postoperative liver function abnormalities, demonstrating the strong compensatory capacity of the child's liver. This paper suggests that if early surgery is possible, preoperative selective hepatic artery embolization should be performed, followed by postoperative chemotherapy, which can improve cure rates and reduce mortality. Additionally, in cases of advanced hepatoblastoma, if the tumor has infiltrated the hepatic porta, the tumor should be as completely resected as possible, but this should not be pursued at the risk of damaging the portal vein, hepatic artery, or left and right hepatic ducts. In summary, for childhood hepatoblastoma, active surgery should be pursued as long as jaundice and ascites do not appear. The belief that the disease is incurable should be abandoned. Similarly, focusing solely on surgery while neglecting preoperative and postoperative chemotherapy is also incomplete.