Celecoxib抗肝癌作用及临床意义

目的：观察特异性环氧合酶-2（cyclooxygenase-2，COX-2）抑制剂Celecoxib对肝癌细胞增殖和凋亡的影响，探讨应用于肝癌治疗的临床意义。方法：用MTT法观察Celecoxib对肝癌细胞增殖的影响；透射电镜及流式细胞仪观察Celecoxib诱导肝癌细胞凋亡的作用、对细胞周期的影响及P-gp表达的变化；用RT-PCR技术观察COX-2、Survivin mRNA药物处理后表达的变化。结果：Celecoxib对肝癌细胞抑制增殖、诱导凋亡呈时间和剂量依赖性；细胞周期分布改变，G0／G1期细胞比例增加；在Survivin高表达的肝癌细胞凋亡过程中，Survivin基因的表达显著下调，MDR／P-gp表达减弱。结论：Celecoxib可能通过诱导细胞凋亡、降低COX-2表达、影响细胞周期分布，发挥抗肿瘤作用；并且可能通过下调Survivin、COX-2表达而对MDR细胞同样有效，有重要的临床应用意义。     

PHA体外增强某些抗肿瘤药物对小鼠肝癌细胞DNA合成的抑制作用

本文通过~3H-TdR体外参入小鼠移植性肝癌细胞DNA合成抑制实验结果表明,PHA体外有增强肿节风和胍唑等抗肿瘤药物对小鼠癌细胞DNA合成的抑制作用,其抑制率与PHA浓度(0.025—0.4mg/ml)无明显关系;而当PHA先与癌细胞悬液混合保温1小时后再加入抗肿瘤药物(胍唑)继续保温1.5小时,则比PHA、抗肿瘤药物(胍唑)和癌细胞悬液三者同时进行保温的抑制率有明显增高,两者有显著性差异(p<0.01)。     

Hepatocarcinoma in noncirrhotic liver

Hepatocellular carcinoma (HCC) usually develops in patients with liver cirrhosis or chronic liver disease. These tumors are highly infrequent in patients without precipitating factors. We present a series of four patients with nonfibrolamellar HCC arising in healthy liver. None of the patients had viral infection, or showed alcohol abuse and/or hemochromatosis. Three patients underwent surgery. The clinical characteristics, therapeutic options, and survival and recurrence rates in this type of tumor are discussed.     

身体质量指数与肝癌患者术后肝功能预后的关系

目的 探讨身体质量指数(BMI)与肝癌患者手术后肝功能恢复的关系.方法 按照BMI把患者分为正常体质量组、超体质量组和肥胖体质量组.每组患者记录手术前后白蛋白、总胆红素、谷丙转氨酶(ALT)、谷草转氨酶(AST)、谷氨酰转肽酶(GGT)、碱性磷酸酶(ALP)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)低...     

Child-Pugh C级伴肝炎肝硬化的肝癌患者行肝癌切除术分析

目的：探讨Child-Pugh C级伴有肝炎肝硬化的肝癌患者行肝癌切除术增加可行性的方法,减少手术死亡率。方法：对我院2005年6月~2010年6月收治的33例行肝癌切除术的Child-Pugh C级伴有肝炎肝硬化的肝癌患者进行回顾性分析。结果：手术失血量为300～3 500 ml,平均（1 407.3±122.0）ml;手术时间2.3～9.0 h,平均（5.3±1.2）h。33例肝癌患者死亡5例,余28例术后出现腹水、胆漏、感染、急性肾功能衰竭等各种并发症62例次,经对症治疗均痊愈出院。结论：Child-Pugh C级伴肝炎肝硬化的肝癌患者行肝癌切除术难度大、风险大,但只要选择合理术式,术中控制出血量,加强围术期治疗,手术是相对可行和安全的。     

Descriptive study of hepatocellular carcinoma in noncirrhotic liver

Introduction and objective

Hepatocellular carcinoma (HCC) is the sixth leading cause of cancer. In western countries its impact is steadily growing and most of these tumors arise in cirrhotic liver. The aim of this study was to evaluate the incidence and characteristics of HCC developing in noncirrhotic patients. Methods: We conducted a retrospective review of 469 patients diagnosed with HCC between January 2003 and December 2007. Patients who met the histological criteria, or a combination of clinical, laboratory, imaging and hemodynamic criteria for the absence of cirrhosis were included.

Results

We identified 29 patients with a diagnosis of HCC in non-cirrhotic liver (6.2%). Most (86.2%) were men and the median age was 61.6 (23 - 82) years. The most frequent histology of the liver was mild-moderate liver fibrosis (68.9%) and 62.1% of the patients were asymptomatic at diagnosis. HCC was a solitary nodule in 86.2%, and the median size of the main nodule was 46 (20 - 150) mm. Macroscopic vascular invasion was demonstrated in two patients and bone metastases in a further two patients. Active treatment was provided in 25 patients, consisting of tumoral resection in 15, radiofrequency ablation in six and transarterial chemoembolization in four. The overall cumulative survival at 1, 2 and 3 years was 84.3%, 67.2% and 50.1%, respectively.

Conclusion

HCC arising in non-cirrhotic liver is uncommon and there is wide tumor extension at diagnosis. Nevertheless, in most patients, treatment with curative intent can be applied, achieving better survival than that expected patients with cirrhosis.     

选择性出入肝血流阻断技术在右半肝切除术中的应用

目的比较两种肝脏血流阻断方法在因肝脏恶性肿瘤行右半肝切除术中的作用,评价右半肝出入肝血流阻断技术在右半肝切除中的应用价值。方法将49例肝癌行右半肝切除的患者分为右半肝入肝血流阻断组（n=22）和右半肝出入肝血流阻断组（n=27）。比较两组患者术中出血量、输血患者比例、术后并发症以及术后肝功能的恢复等指标。结果两组患者术后输血比例差异无统计学意义（P〉0．05）,右半肝入肝血流阻断组有1例患者术后死于肝脏功能衰竭。右半肝出入肝血流阻断组术后并发症数量明显减少、无患者死亡,术中出血量明显低于右半肝入肝血流阻断组（P〈0．05）,且术后第7天的肝脏功能恢复明显优于右半肝入肝血流阻断组（P〈0．05）。结论右半肝出入肝血流阻断技术可以提高因肝脏肿瘤而行右半肝切除的成功率和患者对手术耐受性,为右半肝切除手术提供了一个安全、合理的手术方式。     

UBE2D2基因在肝癌细胞中的作用及不同中医治法对其调控作用的影响

目的:观察不同中医治法对大鼠肝癌UBE2D2表达的调控差异,以及UBE2D2在人肝癌细胞增殖中的作用。方法:采用DEN诱发大鼠肝癌,分别经中药健脾益气、清热解毒、活血化瘀等治疗后,Affy-metrix rat 230A GeneChip arrays检测肝癌组织UBE2D2表达的差异;设计2个人UBE2D2基因siRNA靶点,将重组质粒经脂质体转入SMMC-7721人肝癌细胞株,MTT法检测细胞生长增殖情况、Realtime-PCR检测该基因的表达差异。结果:芯片结果显示,UBE2D2基因在大鼠肝癌形成后表达显著增加,不同中医治法对其具有不同程度的下调作用,其中健脾理气法下调作用较明显;采用MTT法筛选到1个UBE2D2基因RNA干扰有效靶序列,转染6 d后细胞的生长增殖得到了明显的抑制(与阴性对照组相比,P<0.01);实时荧光定量PCR检测表明,转染6 d后该基因的表达明显降低。结论:UBE2D2基因的高表达与肝癌细胞恶性增殖有关,而中药健脾理气治法对其具有下调作用。     

心理干预对肝癌术后患者负性情绪的影响效果研究

目的:探讨心理干预对肝癌术后病人负性情绪的影响,以提供减轻肝癌术后患者焦虑、抑郁水平的有效途径。方法:采用随机分组法将66例肝癌术后病人分为对照组33例,干预组33例。对照组给予常规护理,干预组由专职护士进行综合性心理干预。于术前、术后1周分别采用焦虑自评量表(SAS)和抑郁自评量表(SDS)对其负性情绪的相关因素进行问卷调查。结果:术后1周对照组和干预组SAS/SDS评分有显著性差异(P=0.000),差异具有统计学意义。结论:综合性心理干预能有效缓解肝癌术后病人负性情绪程度,使患者顺利度过围手术期。