Oncol2012: 原发性肝细胞肝癌CEACAM1细胞膜表达缺失提示患者行肝脏移植术后早期复发的风险增高

背景：原发性肝细胞肝癌组织CEACAM1表达缺失提示患者行根治性切除术后不良预后。本研究的目的在于讨论CEACAM1在原发性肝细胞肝癌组织中的表达,以及不同表达方式对患者行原位肝移植术后肿瘤复发的风险影响。 材料与方法：获取48例行原位肝移植术的原发性肝细胞肝癌患者肿瘤标本。免疫组化法检测肿瘤标本中CEACAM1的表达。统计学分析肿瘤标本中不同表达方式的CEACAM1和患者临床病理指标之间的关系,并将不同CEACAM1表达方式和肿瘤的复发时间进行统计学分析。 结果：所有48例原发性肝细胞肝癌患者的肿瘤标本中,25例患者标本为CEACAM1肝癌细胞膜表达,19例患者标本为CEACAM1肝癌细胞质内表达,4例患者标本CEACAM1表达缺失。原发性肝细胞肝癌标本CEACAM1细胞膜表达缺失和肿瘤大小、肿瘤数量、血清甲胎蛋白浓度密切相关(P<0.05)。单因素分析结果显示,原发性肝细胞肝癌CEACAM1细胞膜表达缺失和患者肝移植术后肿瘤的早期复发相关(P=0.027)。多因素分析结果显示,原发性肝细胞肝癌CEACAM1细胞膜表达缺失可以作为预测患者行肝移植术后肿瘤复发的一个独立指标(P=0.037)。 结论：原发性肝细胞肝癌CEACAM1细胞膜表达缺失提示肝癌细胞侵袭性增强,且可以作为预测移植术后肿瘤复发的一个独立指标。     

吲哚菁绿清除试验在肝脏缺血再灌注损伤中的临床评价

目的探讨吲哚菁绿(ICG)清除试验评价肝脏缺血再灌注损伤(HIRI)的临床意义。方法收集第二军医大学附属东方肝胆外科医院2010年6月-2010年12月26例原发性肝癌行肝癌切除术的患者,随机分为对照组(行常规手术,14例)和缺血预处理(IPC)组(切肝前对第1肝门实施10 min缺血及10 min再灌注,12例)。比较两组患者的术前,术后第1、3、7天的ICG清除率(ICGK),以及血清总胆红素(TBIL)、总胆汁酸(TBA)、白蛋白(ALB)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)的水平。结果 IPC组在术后第1、3、7天的血清ALT水平均显著低于对照组(P值均<0.05),IPC组在术后第1天的AST水平显著低于对照组(P<0.05)。两组间术后同一时间点ICGK、TBIL、TBA、ALB的差异均无统计学意义(P值均>0.05)。结论 ICG清除试验作为一种评价肝脏储备功能的指标并不能很好的评价HIRI。     

敷和备化方治疗原发性肝癌介入术后综合征40例

目的 观察敷和备化方对原发性肝癌介入术后综合征的临床疗效.方法 80例患者随机分为治疗组、对照组各40例.治疗组肝动脉化疗栓塞(TACE)后服用敷和备化方,对照组TACE后不服中药.观察2组治疗前后症状积分的变化,肝功能指标(碱性磷酸酶、门冬氨酸氨基转移酶、丙氨酸氨基转移酶)的变化,行为状态Karnofsky评分分级,肿瘤标志物甲胎蛋白(AFP)的变化等.结果 治疗组对发热、恶心呕吐、腹胀、黄疸、胁痛等症状的改善优于对照组(P＜0.05),可明显提高患者生活质量(P＜0.05),有效减轻肝功能损害(P＜0.05),降低AFP含量(P＜0.05).结论 敷和备化方治疗原发性肝癌介入术后综合征,能有效改善患者临床症状,降低因肿瘤原因升高的肿瘤标志物AFP含量,改善肝功能指标,提高患者术后的生活质量.     

肝癌肝移植术前降期中载药微球经动脉化疗栓塞应用效果观察

目的:探究载药微球经动脉化疗栓塞(DEB-TACE)与常规经动脉化疗栓塞术(cTACE)在肝癌肝移植术前降期治疗中的应用价值。方法:选取2015年1月至2022年1月我院74例因肝细胞性肝癌(HCC)行经典原位肝移植患者的临床资料，开展回顾性研究。其中36例肝移植术前行DEB-TACE降期治疗，作为DTACE组，38例肝移植术前行cTACE降期治疗，作为cTACE组。比较两组降期治疗疗效、血清肿瘤标志物[甲胎蛋白(AFP)、糖类抗原199(CA199)、E-钙黏蛋白(EC)]、肝功能指标[天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)]、预后相关标志物[血管内皮生长因子(VEGF)、分泌型蛋白Dickkopf-1(DKK1)、CD24]、不良反应发生率、肝移植术后1年复发转移情况，采用酶联免疫吸附法检测血清VEGF、DKK1、CD24水平。结果:DTACE组降期治疗缓解率(83.33%)与cTACE组(71.05%)对比差异无统计学意义(P>0.05);DTACE组治疗后血清AFP、CA199、EC水平均低于cTACE组，差异具有统计学意义(P&...     

索拉菲尼治疗肝癌肝移植术后肿瘤复发患者的疗效及安全性分析

目的探讨索拉菲尼治疗原发性肝细胞癌肝移植术后肿瘤复发患者的临床疗效和安全性。方法 10例肝移植术后肿瘤复发患者,确诊复发后即口服索拉菲尼400 mg,每日两次治疗(A组);8例未接受索拉菲尼治疗的肝癌肝移植术后肿瘤复发患者(B组);同期接受相同剂量的索拉菲尼治疗的肝癌患者25例(C组)。比较3组患者的带瘤生存时间、索拉菲尼的毒副作用及其他不良反应发生情况。结果 3组患者的带瘤生存时间分别为5~22个月(中位数10个月)、1~8个月(中位数4个月)和2~21个月(中位数4个月),三组之间整体间差异有统计学意义(K-M法,以log-rank检验,P=0.045)。两组肝移植患者没有发生急性排斥反应,但服用索拉菲尼组有1例患者因上消化道出血而死亡,服用索拉菲尼的两组患者不良反应发生率差异无统计学意义(P>0.05)。结论索拉菲尼能明显延长肝癌肝移植术后肿瘤复发患者的生存期,并不增加排斥反应发生率。     

肿瘤异常蛋白(TAP)在肝癌诊断及预后评估中的应用价值

目的:探讨肿瘤异常蛋白(TAP)在肝癌患者中的表达水平及对肝癌的诊断价值和复发评估作用。方法:选取原发性肝癌患者、良性肝病患者及健康体检者各50例,分别检测各组TAP、AFP水平,比较分析各组TAP水平差异以及术后TAP变化情况与肝癌患者无复发生存率(RFS)的相关性。结果:原发性肝癌组患者TAP水平显著高于良性肝病组与对照组(P<0.05),TAP与AFP联合检测对原发性肝癌的诊断敏感性显著高于单独检测组(P<0.05)。50例肝癌患者的TAP术后1个月水平较术前显著下降,且以术后1个月TAP水平评估为PR组的患者无复发生存率(RFS)显著高于SD+PD组(P<0.05)。结论:肿瘤异常蛋白(TAP)作为新的肿瘤标志物,在肝癌的诊断和复发评估中有着潜在的应用价值。     

海藻玉壶汤对Hep3B肝癌裸鼠肝功能及CyclinD1、Bax蛋白表达的影响

目的:观察海藻玉壶汤对人肝癌移植瘤裸鼠的抗癌作用,以及对肝功能指标血清丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天冬氨酸氨基转移酶(aspartic transaminase,AST)和细胞周期蛋白D1(CyclinD1)、细胞凋亡调控基Bax蛋白表达的影响。方法:30只BALB/c裸鼠皮下接种Hep3B细胞,建立肝癌异位移植瘤模型,分为模型组(9 g·L~(-1)氯化钠溶液灌胃),阳性对照组(盐酸多柔比星腹腔注射),海藻玉壶汤高剂量组、中剂量组、低剂量组(海藻玉壶汤灌胃)。治疗21 d后,称量小鼠体质量,取肿瘤组织测瘤质量、常规HE染色;免疫组织化学检测肿瘤组织CyclinD1、Bax;生化分析仪检测血清ALT、AST。结果:各组小鼠体质量比较,差异无统计学意义(P0.05)。海藻玉壶汤高剂量组、中剂量组、低剂量组与模型组比较,移植瘤瘤质量较低,差异具有统计学意义(P0.05)。HE染色观察肿瘤组织病理学可见治疗组不同程度肿瘤细胞灶性坏死,胞核固缩深染。免疫组织化学可见海藻玉壶汤各组CyclinD1蛋白阳性表达下降(P0.05),Bax蛋白阳性表达增强(P0.05)。结论:海藻玉壶汤可剂量依赖性地抑制裸鼠Hep3B移植瘤生长,一定程度上保护肝功能,并通过影响细胞周期和凋亡发挥抗肿瘤作用。     

原发性肝癌切除术后复发患者的补救性肝移植治疗疗效分析

目的:比较原发性肝癌切除术后复发患者与初次发生肝癌患者肝移植术后生存率的差异,筛选肝移植术后病死率相关的危险因素.方法:回顾性分析2003年7月至2005年8月收治的77倒原发性肝癌患者.其中15例为术后复发肿瘤患者(复发组),62例为初发肿瘤患者(对照组).比较两组患者术后生存率.对所有患者的临床数据进行分析,并通过Cox风险比例模型筛选患者移植术后生存率的影响因素.结杲:患者平均年龄为(48.6±4.3)岁.术后随访(20±3.7)个月,复发组和对照组分别有3例(20%)和15例(24.2%)患者死亡,移植术后30 d内病死率分别为6.7%和1.6%.Cox风险比例模型提示.术前高胆红素、最大肿瘤直径较大、内眼癌栓、术后输血以及肿瘤家族史是术后死亡的危险因素.结论:复发和初发肝移植患者术后生存率无显著差异;术前高胆红素、最大肿瘤直径较大、肉眼癌栓、术后输血以及肿瘤家族史是移植术后病死的危险因素.     

四君子汤合血府逐瘀汤治疗肝癌的效果

目的:研究并分析四君子汤联合血府逐瘀汤对于治疗肝癌的临床效果.方法:选取2015年4月-2017年5月期间在我院收治并确诊的肝癌患者60例,将患者随机分为研究组和对照组,每组30例患者,对照组采用常规治疗,研究组在对照组的基础上采取四君子汤合血府逐瘀汤进行治疗.对比分析两组患者术后肝功能恢复情况以及术后天冬氨酸氨基转移酶(AST)、谷氨酸氨基转移酶(ALT)水平变化.结果:研究组术后3天肝功能损伤率(33.3%)低于对照组(50.0%),且术后一周肝功能损伤率(10.0%)也低于对照组(33.3%),并且研究组术后3天以及7天天冬氨酸氨基转移酶(AST)、谷氨酸氨基转移酶(ALT)的水平也显著低于对照组.结论:对于肝癌术后患者采用四君子汤联合血府逐瘀汤可以促进患者肝功能恢复速度以及降低天冬氨酸氨基转移酶以及谷氨酸氨基转移酶水平,有利于肝癌患者预后,值得在临床上进行推广应用.     

健脾益气消癥法治疗中晚期原发性肝癌的临床观察

观察健脾益气消癥法对中晚期原发性肝癌患者肝功能及生活质量的影响。方法：46例经彩超、CT、核磁共振成像及甲胎蛋白检查,诊断为中晚期原发性肝癌的患者,随机分成两组：治疗组26例、对照组20例。治疗组采用健脾益气消癥中药配合艾迪注射液治疗;对照组只采用艾迪注射液治疗。2个月后观察对丙氨酸氨基转移酶（ALT）、甲胎蛋白（AFP）、患者生活质量的影响。结果：两组治疗后ALT明显降低,与各自治疗前比较差异均有非常显著性（P〈0.01）,治疗组优于对照组;治疗后AFP有不同程度的升高,治疗组升高较少;治疗组有效率明显高于对照组（P〈0.01）。结论：健脾益气消癥法治疗原发性肝癌能保护肝功能,提高肝癌患者的生活质量,中药汤剂联合艾迪注射液治疗原发性肝癌有一定优势。     

Liver

<正>209087 Clinical analysis of outcome of invasive fungal infection after kidney transplantation/Chen Guodong(陈国栋,Dept Transplant Surg,1st Hosp,Sun Yat sen Univ, Guangzhou 510080)…∥Chin J Organ Transplant. -2009, 30(10). -616～619 Objective To explore the outcome of invasive fungal infection in kidney transplantation and the influencing factors.     

Liver

Prevention and treatment of artery complication after liver transplantation by HBO , Clincal feature of cytomegabvirus pneumonia in orthtopic liver-transplantation and treatments, Risk factors of diabetes mellitus following orthotopic liver transplantation , Re-infection of hepatitis B virus after liver transplantation , Diagnosis and treatment of fungal infection after orthotopic liver transplantation , Two successful adult-to-adult living donor liver transplantation using dual grafts     

Liver

<正>209461 Intraoperative ligation of recipient’s portasystemic shunt in liver transplantation/Chen Litian(,Organ Transplant Center,Tianjin 1st Centr Hosp Tianjin 300192)…∥Chin J Gen Surg.-2009,25(4).-489～491Objective To investigate the clinical significance of ligating the portasystemic shunt confirmed by preoperative CT evaluation during orthotopic liver transplantation.Methods From January 2007 to August 2008,35 patients in Tianjin First Central Hospital underwent preoperative three-dimensional CT scan,among them 23 patients had spontaneous major portasystemic shunts,the other 12 patients did not have portasystemic shunts.16 out of the 23 cases with significant shunts underwent shunt ligation based on portal blood flow volume measured by intraoperative portal vein flowmetry.The shunt of the other 7 patients were left untreated.Results The portal blood flow in the 12 patients without portasystemic shunt judged by preoperative CT scanning were(1 101±70)ml/min.The shunts in 7 patients with portal blood flow greater than 1 000 ml/min were not ligated,that of the 16 patients with portal blood flow volume lower than 1 000 ml/min were ligated.The portal blood flow volume in those 16 patients before and after ligating the shunt were(657±112)ml/min and(1 136±161)ml/min,respectively(P<0.05).Postoperatively 2 patients suffered from portal vein thrombosis,among them 1 patients suffered from intermittent disturbance of consciousness,2 patients died within 3 months,with one died of respiratory failure from pulmonary aspergillus infection,one died of hepatic failure in 2 months after operation because of graft dysfunction.The other 19 patients with normal blood flow and well-functioning graft were alive.Conclusion The ligation of portasytemic shunt is mandatory in patients when pretransplant CT evaluation showing a major porto-systemic shunts and portal blood flow volume was less than 1 000 ml/min.5 refs,2 figs.     

Liver

<正>209293 Probing into indication of living-related Liver Transplantation for Wilson’s disease/Cheng Feng(Liver Transplant Center,1st Hosp Nanjing Med Univ,Key Lab Living Donor Liver Transplant,Minist Public Health,Nangjing 210029)…∥Chin J Surg.-2009,47(6).-437~440Objective To probe into indication of living-related liver transplantation(LRLT)for Wilson’s Disease.Methods From January 2001 to February 2007,thirty-seven living-related liver transplants were performed.A retrospective analysis was carried on outcome of those patients.The indications for LRLT were acute hepatic failure in 3 patients and chronic advanced liver disease in 32 patients including 13 patients with Wilsonian neurological manifestations.Two patients presented with severe Wilsoian neurological manifestations even though their liver functions were stable.According to the scoring system for evaluation of the neurological impairment in Wilsion disease based on neurological signs and functions(total score was 30),the pre-transplantation score of those patients with neurological manifestations was 15.9±4.3(n=15).Results Thirty-seven patients were followed up for 20-93 months.The survival rates of post-transplant patients and grafts at 1,3,and 5 year were 91.9%,83.8%,75.7%,and 86.5%,78.4%,75.7%,respectivly.Postoperative surgical complications occurred in 2 donors with bile leakage required drainage,in 2 recipients with hepatic thormbosis underwent retransplantation of cadeveric liver and in 1 recipient with hepatic stenosis required balloon dilatation.Neurological function was improved in all recipients and the score of posttransplantation at 6,12,18,24,and 30 months was 17.5±3.7(n=13);21.0±4.3(n=12);23.9±3.9(n=10);26.6±2.2(n=10)and 28.1±1.9(n=7)respectively.Conclusion Patients with acute hepatic failure or patients with severe liver disease unresponsive to chelation tratment should be treated with LRLT.Early transplantation in patients with an unsatisfactory response medical tratment may prevent irreversible neurologica     

Liver

Alleviation of ischemia-reperfusion injury in rat liver donors by induction of exogenous hTERT gene;Effects of surgical technique on acute renal failure after orthotopic liver transplantation in patients with end-stage liver disease at high risk： a report of 90 eases;Timing for liver transplantation for chronic severe hepatitis;Analysis of bacterial variance and drug resistance after orthotopic liver transplantation;The influence of splenectomy on orthotopic liver transplantation and its management     

Liver

<正>209604 The suppressive effect of CD8+ CD28-regulatory T cells from spontaneous tolerance models on the acute rejection responses in rat liver transplantation/Chen Ning(陈宁,Dept Gastroenterol,Peking Univ Peop Hosp,Beijing 100044)…∥Chin J Organ Trans-plant. -2009,30(9). -524 ～526     

探讨脂肪肝供肝在肝脏移植中的价值

目的探讨应用不同脂肪沉着程度供肝对肝移植患者预后的影响。方法选取64例进行肝移植术患者,依据供肝浸润程度,随机分为轻度脂肪肝组、中度脂肪肝组、重度脂肪肝组、无脂肪肝组共四组,每组各16例,比较四组患者肝功能(主要观察ALT、AST指标)、入住ICU的平均时间、1年移植物成活率、移植物原发无功发生率。结果轻度脂肪肝组入住ICU的平均时间、ALT和AST水平、移植物原发无功发生率与无脂肪肝组接近;中度脂肪肝组入住ICU平均时间、ALT和AST水平均较轻度组和无脂肪肝组明显增高,P0.05;重度脂肪肝组入住ICU平均时间、ALT和AST水平、移植物原发无功发生率明显较前三组为高,P0.05。结论轻、中度肝脏脂肪浸入可作为肝移植供肝,重度脂肪肝不能作为供肝的选择目标。     

Microenvironment of Liver Regeneration in Liver Cancer

The occurrence and development of liver cancer are essentially the most serious outcomes of uncontrolled liver regeneration. The progression of liver cancer is inevitably related to the abnormal microenvironment of liver regeneration. The deterioration observed in the microenvironment of liver regeneration is a necessary condition for the occurrence, development and metastasis of cancer. Therefore, the use of a technique to prevent and treat liver cancer via changes in the microenvironment of liver regeneration is a novel strategy. This strategy would be an effective way to delay, prevent or even reverse cancer occurrence, development and metastasis through an improvement in the liver regeneration microenvironment along with the integrated regulation of multiple components, targets, levels, channels and time sequences. In addition, the treatment of "tonifying Shen (Kidney) to regulate liver regeneration and repair by affecting stem cells and their microenvironment" can regulate "the dynamic imbalance between the normal liver regeneration and the abnormal liver regeneration"; this would improve the microenvironment of liver regeneration, which is also a mechanism by which liver cancer may be prevented or treated.     

化肝汤1号治疗酒精性肝纤维化症状及肝功能改变

目的观察活血化瘀、软坚散结药配伍治疗肝纤维化时对患者主、次症状改变及肝功能的影响。方法将确诊为酒精性肝纤维化患者90例,随机分为三组,治疗组采用自制方剂化肝汤1号(醋鳖甲、黄芩、柴胡、赤芍等),对照组1采用凯西莱治疗,对照组2采用化肝汤1号和凯西莱联合治疗,疗程3个月。观察三组患者治疗前后主、次症状改善情况,血清天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、γ谷氨酰转肽酶(γ-GT)变化。结果三组治疗后的临床疗效比较差异无统计学意义(H=2.5897,P>0.05)。三组治疗后肝功能指标均有改善,与治疗前比较,差异有统计学意义(P<0.05)。结论化肝汤1号可有效地降低肝细胞的损害程度,促进受损细胞修复,从而改善肝功能。