肝X受体与肝癌研究进展

原发性肝癌是我国最常见消化系统肿瘤之一,肝癌侵袭性强且复发率高,总体疗效往往不满意.肝X受体(liver X receptors,LXRs)是核受体超家族成员之一,最初发现其参与可调节胆固醇代谢及免疫应答.目前,细胞及分子生物学研究不断深入并取得新的进展,LXR在肝脏疾病尤其是肝癌的发生发展中作用明显,提示LXR是肝癌...     

肝移植在结直肠癌肝转移中的价值

结直肠癌是全球范围内发病率和死亡率均高的恶性肿瘤之一,早期容易发生转移,而肝脏恰是结直肠癌远处转移的最常见器官.随着肝移植技术的发展与进步,不可切除性结直肠癌肝转移患者获得了长期生存的新机遇.近年来,挪威奥斯陆大学医院在肝移植治疗不可切除性结直肠癌肝转移的领域中取得了一系列巨大突破,引起了世界各地学者的广泛关注.随后,...     

The expression of ETAR in liver cirrhosis and liver cancer

Background: To investigate the expression of endothelin receptors in liver diseases and discuss its role in the process of liver cirrhosis and liver cancer.

Research design and methods: We examined the expressions of ETAR, ETBR and α-SMA in tissue samples using western blotting analysis. Furthermore, immunofluorescence was used to locate ETAR expression in hepatic stellate cells (HSCs) and hepatic sinusoidal endothelial cells (HSECs), we calculated the percentage of positive cells and then analyzed its relation with clinical indexes.

Results: According to the western blotting analysis, the expression of ETAR was high in hepatic hemangioma and liver cancer tissues and ETBR was highly expressed in cirrhosis tissues. The immunofluorescence results demonstrated that the expression of ETAR was elevated in hepatic hemangioma and liver cancer tissues. Moreover, ETAR expression was found in both HSCs and HSECs. Finally, the statistical analysis revealed that the number of positive ETAR cells was correlated with the clinical index platelets (PLT), alanine transaminase (ALT) and diameter of portal vein.

Conclusion: Endothelin receptors express differently in liver cirrhosis and liver cancer tissues and play a role in hepatic diseases by affecting HSCs and HSECs.     

肝癌组织端粒酶活性表达及DNA含量的研究

目的研究肝癌组织、癌旁组织端粒酶活性的表达及DNA含量的变化.方法取肝癌手术标本30例,每例均取癌组织、癌旁肝组织及外侧切缘肝组织.采用PCR-ELISA法检测其端粒酶的活性;流式细胞仪技术检测细胞DNA含量,DNA倍体及细胞分期.结果肝癌组织端粒酶阳性率为76.7%(23/30),癌旁组织端粒酶阳性率为16.7%(5/30),外侧切缘肝组织无阳性(0/30),肝癌组织与癌旁组织及外侧切缘肝组织端粒酶的表达有显著差异(P《0.01).癌旁组织与外侧切缘肝组织端粒酶的表达也有显著差异(P《0.05).肝癌组织与外侧切缘肝组织DNA异倍体表达率有显著差异(P《0.05).端粒酶阳性及阴性组间DNA异倍体率、DNA指数(DI)、S期细胞比率(SPF),细胞增殖指数(PI)未见明显变化.结论端粒酶与肿瘤的恶性行为存在一定的密切关系,其作为肝癌诊断的分子标志具有一定的价值.同时检测DNA倍体类型可进一步提高其临床参考价值.     

β-catenin在小鼠化学肝癌形成过程中的动态变化

目的:检测β-catenin在化学诱导C57BL/6J小鼠肝癌过程中各时期的动态变化。方法:化学法[二乙基亚硝胺(diethylnirtosamine,DEN)/四氯化碳(carbon tetrachloride,CCl4)/乙醇]诱发50只C57BL/6J雄性小鼠肝癌,对照组为45只正常C57BL/6J雄性小鼠。观察小鼠成瘤情况和生长状态,对每2周定期处死小鼠获得的组织标本分别进行病理学切片观察,并采用荧光实时定量PCR、免疫组织化学法和蛋白质印迹法分别检测β-catenin mRNA和蛋白的表达情况。结果:化学诱导20周后,成功诱发小鼠肝癌。荧光实时定量PCR第4周起小鼠肝癌组织中β-catenin的表达高于正常对照组,差异有统计学意义(P<0.05)。随着诱癌时间的增加,β-catenin的表达量呈上升趋势,第18和20周时诱癌组β-catenin的表达明显高于前一诱癌组(P<0.05)。蛋白印记法及免疫组化检测发现诱癌组第4周起至第14周细胞核内β-catenin有表达,细胞质内的表达也较正常对照组多,细胞膜表达减弱,这期间诱癌组间细胞核和细胞浆内β-catenin表达无明显差异。第16周可发现细胞浆内的β-catenin蛋白表达较之前时间组降低,第20周降至最低。而第18周和第20周细胞核的β-catenin蛋白表达明显多于前面时间段,第20周最多。细胞膜无表达。结论:随着肝癌演变,细胞浆内的β-catenin蛋白有可能向细胞核内移位,致使细胞核内β-catenin蛋白更进一步累积,激活一系列靶基因,导致肝癌形成。β-catenin蛋白在细胞膜、细胞浆和细胞核中分布在正常肝脏组织、肝硬化、肝癌这一过程中均不相同,表明β-catenin与肝癌的发生发展有密切关系。     

腹腔镜下肝癌切除术对患者免疫功能和肝功能的影响

目的探讨腹腔镜下肝癌切除术对患者免疫功能和肝功能的影响。方法根据手术方法不同将80例肝癌患者分为微创组(行腹腔镜下肝癌切除术)和开腹组(行传统开腹手术),每组40例。观察并比较两组患者的手术时间、术中出血量、切口长度、引流管留置时间、住院时间,并对两组患者术前、术后1天、术后3天的丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、间接胆红素(DBIL)水平及外周血CD3^+、CD4^+、CD8^+水平进行比较。结果微创组患者的手术时间明显长于开腹组,切口长度、引流管留置时间、住院时间均明显短于开腹组,术中出血量明显低于开腹组(P﹤0.01);术后1天、术后3天,微创组患者的血清ALT、AST水平及外周血CD8^+水平均低于开腹组,外周血CD3^+、CD4^+、CD4^+/CD8^+水平均高于开腹组,差异均有统计学意义(P﹤0.05)。结论腹腔镜下肝癌切除术对患者免疫功能、肝功能的影响较传统开腹手术小。     

紧贴肝门大血管的肝癌切除术

Objective To study the surgical experience with resection of a hilar liver cancer close to major vessels and how to improve the therapeutic result. Methods From January 1990 to June 1997, 58 hilar liver tumors (segment I, IV, V, VIII) were resected. The tumors in these 58 patients were within a distance of 1 cm to major hepatic vessels (retrothepatic inferior vena cava, root of hepatic veins, and left or right trunk of portal vein). The diameter of the tumors was > 5 cm in 42 cases and < 5 cm in 16 cases, respectively. The size of the largest tumor was 20 cm × 18 cm × 18 cm. The surgical techniques are summarized, and the prevention and treatment of postoperative complications are discussed. Results All operations have been carried out successfully and had a regular follow-up until now with 1−, 3− and 5− year survival rate of 71%, 38% and 25%, respectively. Conclusion While hilar liver surgery is quite difficult and risky, the safety and therapeutic of surgery could be improved by observing a meticulous surgical technique, and by preventing and treating postoperative complications by multimodal measures.     

Mucoepidermoid carcinoma arising from a preexisting cyst of the liver

A case of mucoepidermoid carcinoma of the liver of a 46-year-old female is described. The resected mass from the left lobe of the liver measured 3 X 3 X 2 cm. The cut surface showed a well demarcated white, round shape, and a cystic formation measuring 1.8 X 1.4 cm was present in the center of the mass. Microscopically, the mass showed high-grade-type mucoepidermoid carcinoma, which consisted of squamous cells, mucus-producing cells, and glandular cells. The cystic wall was lined with apparently benign glandular, mucus-producing cells, squamous metaplastic cells, and tumor cells. The tumor was intimately contiguous with the cyst and gradual transition between tumor cells and cystic lining cells was recognized. It is suggested that the mucoepidermoid carcinoma of the liver in the present case was derived from malignant transformation of a preexisting cyst of the liver.     

A contemporary systematic review on liver transplantation for unresectable liver metastases of colorectal cancer

The 5-year overall survival rate of a patient with unresectable metastatic colorectal cancer is poor at approximately 14%. Similarly, historical data on liver transplantation (LT) in those with colorectal liver metastases (CRLM) showed poor outcomes, with 5-year survival rates between 12% and 21%. More recently, limited data have shown improved outcomes in select patients with 5-year overall survival rates of approximately 60%. Despite these reported survival improvements, there is no significant improvement in disease-free survival. Given the uncertain benefit with this therapeutic approach and a renewed investigational interest, we aimed to conduct a contemporary systematic review on LT for CRLM. A systematic review of the literature was performed according to the preferred reporting items for systematic reviews and meta-analysis statement. English articles reporting on data regarding LT for CRLM were identified through the MEDLINE (via PubMed), Cochrane Library, and ClinicalTrials.gov databases (last search date: December 16th, 2021) by 2 researchers independently. A total of 58 studies (45 published and 13 ongoing) were included. Although early retrospective studies suggest the possibility that some carefully selected patients may benefit from LT, there is minimal prospective data on the topic and LT remains exploratory in the setting of CRLM. Additionally, several other challenges, such as the limited availability of deceased donor organs and defining appropriate selection criteria, remain when considering the implementation of LT for these patients. Further evidence from ongoing prospective trials is needed to determine if and to what extent there is a role for LT in patients with surgically unresectable CRLM.     

原发性肝癌综合治疗的现状与展望

回顾近年来原发性肝癌综合治疗进展.分析原发性肝癌的研究现状,总结原发性肝癌的综合治疗的经验.原发性肝癌综合治疗的研究取得了较大进展,肝癌的早诊早治、局部根治切除、二期切除、肝癌复发再切除等外科治疗模式及综合治疗在临床上的广泛应用,大大地改善了病人生存质量,但仍有不少问题需深入研究.原发性肝癌的综合治疗水平有显著提高,但仍存在不少问题需深入研究.     

原发性肝癌伴红细胞增多症1例

1病例报告 男性,67岁,工人。因纳差、消瘦、右上腹疼痛3mo,于2005年10月30日入院。自诉近3年一直颜面部发红,否认肝炎病史及高原生活史。查体：营养中等,面部、颈部潮红,无皮肤黏膜黄染,可见肝掌、蜘蛛痣。腹平坦,肝脾未扪及肿大,移动性浊音（-）。实验室检查：HBsAg（＋）：ALT25U／L,AST43U／L,GGT125U／L,A42．3g／L,G48．4g／L,TB24．3μmol／L,DB6．2μmol／L;BUN4．9mmol／L,     

RESULTS OF HEPATECTOMY FOR HUGE PRIMARY LIVER CANCER

ＲＥＳＵＬＴＳＯＦＨＥＰＡＴＥＣＴＯＭＹＦＯＲＨＵＧＥＰＲＩＭＡＲＹＬＩＶＥＲＣＡＮＣＥＲＬｉＧｕｏｈｕｉ；李国辉；ＬｉＪｉｎｑｉｎｇ；李锦清；ＺｈａｎｇＹａｑｉ；张亚奇；ＣｕｉＳｈｕｚｈｏｎｇ；崔书钟；ＹｕａｎＹｕｎｆｅｉ；元云飞（ＴｕｍｏｒＨｏｓ...     

逆行肝切除治疗难切性肝癌244例报道

目的　逆行肝切除是治疗难切性肝癌的有效方法 ,本文报道了 2 44例临床经验。方法　常规肝切除方法切除困难的 2 44例巨大、显露困难或下腔静脉受累的肝癌采用逆行切肝法结合血管外科技术予以切除 (A组 ) ,同期临床特征类似的 31例肝癌采用常规切肝法切除 ,作为对照 (B组 )。结果　两组均无手术死亡 ,A组与B组相比 ,术中出血量较少 ( 12 90± 998ml比 2 2 86± 136 3ml)、术后胸水发生率 ( 2 6 /2 44比 10 /31)、腹水发生率 ( 72 /2 44比 19/31)、中度到重度黄疸率 ( 14 /2 44比 5 /31)、手术区积液率 ( 17/2 44比 7/31)、膈下感染率 ( 3/2 44比 1/31)、胆漏发生率 ( 2 /2 44比 1/31)、切口感染率 ( 3/2 44比 1/31)以及ALT恢复时间 ( 13.8± 5 .1天比 18.9± 8.9天 )均较低 ,差别具有统计学意义 (P <0 .0 1)。结论　对于难切性肝癌而言 ,逆行肝切除是安全有效的手术方法。     

Management of patients with colorectal liver metastasis in eleven questions and answers

Introduction: Colorectal liver metastasis (CRLM) is the most frequent indication for liver resection in many centers. Recent improvements in oncology, surgery, interventional radiology, pathology and anesthesiology allow curative treatment in a larger proportion of patients with CRLM.

Areas covered: We illustrate the various aspects of the management of CRLM through 11 questions that summarize the topic, from the current obtained survival to future perspectives such as transplantation. The limits of a curative treatment are also presented from different angles, such as the benefits of pathology, the surgical options for extreme resections, the available chemotherapies and their efficacy, or the non-surgical ablative treatments.

Expert commentary: Given the increasing therapeutic possibilities, we strengthen the importance to analyze the situation of each patient with CRLM in a dedicated multidisciplinary team, in order to offer the best individualized treatment combination.     

X-刀对非肝癌组织的放射性效应

目的　研究具有不同内在因素的肝癌在X -刀作用下对非癌组织的放射性效应。方法　选择肝癌体积、X 刀剂量基本相似条件下 ,以ALT(丙氨酸氨基转移酶 )为指标观察具有不同内在因素的肝癌于X 刀术后发生放射性肝损伤的危险性。结果　原发性肝癌于X 刀术后ALT上升值与术前比较具有显著性差异 (P <0 .0 0 1 )。原发性肝癌与转移性肝癌于X 刀术后ALT升、降之差及上升率比较差异非常显著 (P <0 .0 0 1 .P <0 .0 1 )。同时发现X 刀对原发性肝癌组中HBVM(+)和嗜酒因素均有者发生放射性肝损伤的危险性与这两种因素均无者比较差异非常显著 (P <0 .0 0 1 ,OR=2 7.5) ;与转移性肝癌比较亦具有非常显著性差异 (P <0 .0 0 1 ,OR =2 8.2 85)。结论　在X 刀治疗肝癌中对非癌肝组织具有放射性损伤者占 39.1 8% ;其程度及发生率以原发性肝癌为高 ,以同时伴有HBVM(+)及嗜酒因素者为重。     

Combined colon and hepatic resection for synchronous colorectal liver metastases

BACKGROUND AND OBJECTIVES: The surgical strategy for the treatment of resectable synchronous hepatic metastases of colorectal cancer remains controversial. This study was performed to assess the outcome of combined resection of colorectal cancer and liver metastases. METHODS: The perioperative data, morbidity, and survival of the patients who underwent combined colon and liver resections for synchronous colorectal liver metastases from 1988 to 1999 were compared to the parameters of the patients who underwent colon resection followed by resection of liver metastases in a staged setting. RESULTS: 198 hepatic resections were performed, of which 112 procedures in 103 patients were done for metastatic colorectal carcinoma. Twenty six patients (25%) had combined hepatic and colon resection and were compared to 86 patients with metachronous metastases who underwent colon and hepatic resection in the staging setting. Postoperative morbidity was 27 and 35%, respectively. There was no hospital mortality in the combined group vs. 2.3% in the staged group. Blood loss, intensive care unit (ICU) stay and length of postoperative stay (LOS) were similar in both groups. The 5 years cumulative survival of the group after combined surgery was 28% vs. 27% of the group after isolated hepatic resections (P = 0.21). CONCLUSION: Combined colon and hepatic resection is a safe and efficient procedure for the treatment of synchronous colorectal liver metastases. It can be performed with acceptable morbidity and no perioperative mortality. The survival after combined procedure is comparable to the one achieved after staged procedure of colon resection followed by liver resection.     

A technique for isolated hyperthermic liver perfusion

Hyperthermia, either alone or combined with chemotherapy, has been shown to be effective in treating cancer. Because some investigators believe that regional hyperthermia may be more effective than whole body hyperthermia, we developed a technique to heat only the liver to 42-43 degrees for 4 hr. The procedure was adapted from a previously described animal model and was performed in four humans. Vascular isolation of the liver was accomplished by cannulating the hepatic artery, the portal vein, and the inferior vena cava followed by occluding the suprahepatic vena cava and the liver was then perfused with blood and nutrients from an oxygenated reservoir. Preliminary results show radiologic and histologic evidence of tumor necrosis or cessation of tumor growth in three of the patients. We believe this technique is safe enough for clinical experimental use and deserves further investigation.     

结直肠癌肝转移的治疗进展

结直肠癌肝转移是影响结直肠癌预后的重要因素，治疗方案包括手术治疗、化疗（全身静脉化疗和介入治疗）、基因治疗和局部治疗（射频消融、激光消融、无水酒精注射和冷冻切除术）等，其中手术是目前唯一有效的治愈手段，手术死亡率1％～2．8％，术后5年生存率34％-38％，但仅有10％．25％结直肠癌肝转移患者确诊时适合于手术切除，因此各种非手术治疗的作用正日益受到关注。本文对结直肠癌肝转移的综合治疗作一综述。     

靶向治疗技术在肝癌治疗中的应用

靶向治疗技术是治疗肝癌的新途径。目前，肝癌的靶向治疗技术多种多样，本文主要介绍单克隆抗体技术、基因技术和纳米磁性靶向治疗技术在肝癌治疗中的应用和价值。