肝细胞癌根治性切除术标准的探讨

目的 通过对肝细胞癌切除术后无瘤生存影响因素分析,探讨肝细胞癌根治性切除术的标准的建立。方法 运用Ｃｏｘ比例风险生存分析模型对１,４５７例肝细胞癌切除术患者的临床病理因素进行影响因素分析,无瘤生存率采用Ｋａｐｌａｎ－Ｍｅｉｅｒ法计算。     

肝移植治疗原发性肝细胞癌

原发性肝细胞癌是世界范围常见肿瘤，在东南亚、南非等地区每年发病率达30/10万人口，北美及欧洲地区较低，每年2/10万人口。由于肝细胞癌（HOC）具有恶性程度高、起病隐慝、复发率高，其预后很差。一般肿瘤不能切除的病人，从发病起中位生存期仅4-6个月，本文综述肝移植治疗HOC的现状。     

老年患者原发性肝细胞癌肝切除术后疗效分析

目的 探讨老年原发性肝细胞癌患者行肝切除术后的治疗效果.方法 自1989年1月至2008年12月,共有1 225例原发性肝细胞癌患者于我院行肝切除术,挑选其中年龄≥60岁、有完整临床资料及随访结果的112例患者进行回顾性分析,并随机抽取同期年龄＜60岁的135例患者作对照.结果 老年组患者术后并发症发生率为8.9%(1...     

肝移植治疗原发性肝细胞癌的临床研究进展

肝移植治疗原发性肝癌的一个重要问题是病例的选择，现在大多采用的标准是单个肿瘤直径小于5cm，肿瘤个数少于3个，且每个肿瘤直径小于3cm。血管侵犯被看做为肝移植的禁忌证。各种介入治疗可用于肝移植的过渡性治疗。     

原发性肝细胞癌中乙型肝炎病毒基因整合状态研究

目的：探讨原发性肝细胞癌（hepatocellular carcinoma,HCC)与肝硬化（liver cirrhosis,LC)组织中乙型肝炎病毒（HBV）基因各片段的整合情况。方法：采用PCR与Southern杂交技术检测HCC与LC各35例肝组织标本DNA中是否存在HBV基因的整合。结果：HCC组中HBV DNA阳性率为94％（33/35), 其中X片段阳性率为92％（32／35）；HBV DNA整合率为69％（24／35），其中X片段整合率为69％（24／35），LC组中HBV DNA阳性率为94％（33／35），其中X片段阳性率为84％（29／35）；HBV DNA整合率为60％（21／35），其中X片段整合率为40％（14／35）。两组在X片段整合率上存在统计学差异（P＜0．05）。结论：HBV基因的整合在肝硬化与肝癌中是一个普遍的现象。HBV基因的整合是癌变的早期事件。HBV基因中的X片段的整合与HCC关系密切。     

原发性肝细胞癌合并门静脉癌栓非手术治疗进展

正大部分原发性肝细胞癌(HCC)病人在确诊时已处于中晚期,极易合并门静脉癌栓(portal vein tumor thrombus,PVTT),文献~([1])报道PVTT发生率高达44.0%~62.2%,此类病人若不接受治疗,自然生存期仅为2.7~4.0个月~([2-3])。PVTT一方面导致门静脉高压,进而出现难治性腹腔积液,     

原发性肝细胞癌癌栓致梗阻性黄疸18例分析

原发性肝细胞癌是常见的恶性肿瘤。 19%～4 0 %的病例因黄疸就诊且多属晚期〔1〕。多数情况下 ,黄疸是由肿瘤肝内广泛转移、侵犯肝门或由终末期肝功能衰竭引起 ,因此常为死亡先兆。然而 ,极少数情况下 ,肝细胞癌癌栓侵犯导致胆道也可引起梗阻性黄疸〔1～ 4〕。我们回顾性地分析了 18例上述病人的资料 ,现报道如下。资料与方法我院于 1981年 9月至 1996年 9月共收治肝癌90 0例 ,发现原发性肝细胞癌癌栓致阻塞性黄疸 18例 (2 .0 % ) ,均经手术和病理学证实。其中男 14例 ,女 4例 ,年龄 2 4～ 6 8岁 ,平均 50 .5岁。所有病例均行Ｂ超及ＣＴ检查…     

原发性肝细胞癌合并门静脉癌栓研究进展

<正>原发性肝细胞癌在我国的恶性肿瘤发生率排在第四位(29/10万),而死亡率仅次于肺癌。肝癌起病隐匿,大部分患者诊断时已属晚期,预后不甚理想,原发性肝癌合并门静脉癌栓是肝癌治疗的难点。PVTT可引起肿瘤细胞的肝内外播散和转移,还会引起或加重门静脉高压,严重的可导致肝功能衰竭和甚至死亡。如果不治疗,此类患者中位生存期仅为2-4个月[3]。本文对原发性肝癌并发门静脉癌形成的分     

原发性肝细胞癌病人血浆P16甲基化的意义

目的 探讨原发性肝细胞癌病人血浆P^16甲基化的临床意义。方法 2001年4月至2004年1月，应用甲基化特异PCR法检测35例原发性肝细胞癌（hepatocellular carcinoma，HCC）病人肿瘤、肿瘤旁组织及血浆中P^16甲基化的表达状况。结果 P^16甲基化阳性率HCC癌组织34％明显高于癌旁肝硬化／慢性肝炎组织11％（P〈0．01）。50％HCC癌组织P^16甲基化病人血浆可检测到P^16甲基化。血浆P^16甲基化阳性率在血清AFP定量呈正常（AFP〈200μg／L）的19例HCC病人为21％。HCC癌组织，血浆P^16甲基化阳性病人术后1年复发的相对危险度是P^16甲基化阴性的3．34倍（95％的可信区间1．49～8．00），2．69倍（95％的可信区间1．40～5．14）。结论 HCC血浆中P^16甲基化可能与HCC术后复发相关，可能是微创监测HCC术后复发的分子标记物。检测血浆P^16甲基化有助于对血清AFP〈200μg／L的肝癌病人有诊断价值。     

原发性肝细胞癌β-catenin基因突变的研究

β 连环蛋白 ( β ｃａｔｅｎｉｎ)不但在钙粘蛋白 (ｃａｄｈｅｒｉｎ)介导的细胞粘附 ,而且在细胞发育、分化、细胞骨架维持上起重要作用。β ｃａｔｅｎｉｎ基因突变所致 β ｃａｔｅｎｉｎ蛋白异常与结肠癌、黑色素瘤等发生关系密切 ,被认为是候选的癌基因之一〔1〕。有关 β ｃａｔｅｎｉｎ基因在肝癌中突变情况国外报道极少 ,国内尚未见报道。本文研究了上海医科大学肝癌研究所手术切除的 3 4例肝癌标本中 β ｃａｔｅｎｉｎ基因突变 ,现报告如下。1.资料和方法 :( 1)收集上海医科大学中山医院肝癌研究所 1999年 2～ 7月间手术切除的经…     

中晚期肝癌的转化手术切除

原发性肝癌是我国常见恶性肿瘤之一,手术治疗是肝癌根治性治疗方式。对于评估为不可切除的部分中晚期肝癌病人,可以通过一些治疗手段将肿瘤转化为可切除,使这些病人得到手术治疗,获得更好的疗效。     

原发性肝细胞癌术中脱落癌细胞污染手术用物78例分析

目的 探讨原发性肝细胞癌术中手术用物携带脱落癌细胞的情况.方法 78例原发性肝细胞癌术中用物分四组:A.手术器械;B.术者手套;C.器械护士手套及擦器械、回收残线的纱条;D.清洁术野的纱条、纱垫.术中用物生理盐水浸泡、低速离心后,沉淀物瑞氏染色观察,携带癌细胞者为阳性用物.结果 手术用物癌细胞阳性检出率与TNM分期、肿瘤位置、肿瘤大小以及手术方式显著相关.TNM分期Ⅲ期肝癌手术用物癌细胞阳性检出率较Ⅰ、Ⅱ期用物高(56.3％比21.7％,P=0.002);肿瘤位置、大小与手术用物癌细胞阳性检出率显著相关(P=0.003,P=0.001);不规则性肝切除癌细胞检出率显著高于规则性切除(53.8％比26.9％,P=0.019).而且不同的手术用物间癌细胞阳性检出率有显著差异(P=0.008),C组用物癌细胞检出率最高.结论 术中用物癌细胞污染程度与肝细胞癌分期进展、肿瘤位置、大小以及手术方式明显相关,且随用物使用频率、接触范围增加而增加,与用物性质密切相关.     

原发性肝癌自发性破裂一期手术切除

目的探讨、研究原发性肝癌自发性破裂的手术切除和围术期处理技术。方法回顾性总结了1993年1月～2003年8月施行肝癌切除术的32例自发性破裂肝病例,并以同期随机抽取32例非破裂肝癌病例作为对照,综合比较、分析两组病人的术前、中、后的临床资料。结果破裂与非破裂组术前肝功能Child鄄Pugh分级、肿瘤包膜及门静脉浸润,术中肝门阻断时间、术时及住院时间的差异无显著性。破裂组肝脏的肿瘤直径、术中失血量、输血量、术后并发症发生率及住院病死率均较非破裂组显著高。多元统计回归分析显示术中失血量是决定原发性肝癌自发性破裂病人术后并发症发生率之独立因素。进一步分析控制术中失血的方法选择,各组间差异无显著性,但Pringle手法居首位。结论原发性肝癌自发性破裂病人是否作一期手术切除在于术前准确评估及术中能否采用恰当方法有效地控制出血。     

The significance of surgical resection for pulmonary metastasis from hepatocellular carcinoma

BACKGROUND: Pulmonary metastasis, which is the most common type of extrahepatic recurrence of hepatocellular carcinoma (HCC), has been considered unsuitable for surgical resection because most pulmonary metastases are multiple. Until now there have been few reports about surgical resection for pulmonary metastasis from HCC. The aim of the present study was to evaluate the significance of surgical resection for pulmonary metastasis from HCC. METHODS: Among 615 patients who underwent radical hepatic resection for HCC in our hospital over the past 15 years, 8 patients who had developed 1 or 2 pulmonary metastases underwent pulmonary resection for the pulmonary metastases (resection group), the other 6 patients who had developed 1 or 2 pulmonary metastases did not undergo pulmonary resection (nonresection group). The clinicopathologic features and long-term prognosis of the resection group were examined and compared with those of the nonresection group. RESULTS: In the resection group, although intrahepatic recurrences were present before the diagnosis of pulmonary metastasis in 4 patients, they were well controlled by repeated transarterial chemoembolization and/or further hepatic resections. The average survival periods after the pulmonary resection and after the initial hepatic resection were 29 months (range, 5-80 mo) and 61 months (range, 24-133 mo), respectively. No patients in the resection group showed pulmonary recurrence after the pulmonary resection, and the cause of death of the patients in the resection group was not pulmonary metastasis. The survival rate of patients in the resection group was significantly better than that in the nonresection group. CONCLUSIONS: It may be concluded that surgical resection for pulmonary metastasis from HCC might be beneficial in selected patients.     

Long-term surgical outcomes in patients with hepatocellular carcinoma undergoing laparoscopic vs. open liver resection: A retrospective and propensity score-matched study

Background/objectivesThere is limited availability of well-designed comparative studies using propensity score matching with a sufficient sample size to compare laparoscopic liver resection (LLR) vs. open liver resection (OLR) for hepatocellular carcinoma (HCC). We aimed to compare the feasibility and safety of LLR and OLR in patients with HCC.MethodsWe enrolled 168 patients who underwent elective LLR (n = 58) or OLR (n = 110) for HCC in two tertiary medical centers between November 2009 and December 2018. Patients who underwent LLR were propensity score-matched to patients who underwent OLR in a 1:1 ratio. Perioperative and postoperative outcomes and disease-free and overall survival rates were prospectively evaluated.ResultsAmong the 116 patients analyzed, 58 each belonged to the LLR and OLR groups. We performed 85 segmentectomies or sectionectomies, 19 left-lateral-sectionectomies, 9 left-hemihepatectomies, and 3 right-hemihepatectomies. There was no significant difference in age, sex, Child-Pugh class, original liver disease, preoperative alpha-fetoprotein, tumor size, tumor location, overall morbidity, and operative time. There was a significant difference in the length of postoperative hospital stay between the two groups (LLR vs OLR; 8 vs 10 days, p = 0.003). The 1-, 3-, and 5-year overall survival rates in the LLR and OLR groups were 96.6%, 92.8%, and 73.3% and 93.1%, 88.8%, and 76.1%, respectively (p = 0.642). The 1-, 3-, and 5-year disease-free survival rates in the LLR and OLR groups were 84.4%, 64.0%, and 60.2% and 93.1%, 67.4%, and 63.9%, respectively (p = 0.391).ConclusionLLR for HCC can be performed safely with acceptable short-term and long-term outcomes compared with OLR.     

肝细胞肝癌切除后复发（欧洲经验）

目的 探讨肝细胞肝癌切除后复发的预后相关因素及合理治疗方法。方法 １９８３年１月至１９９７年１月２７１例肝癌切除后有１３４例复发，对其一般情况，肿瘤特性及外科措施进行多因素分析，同时比较复发后不同治疗方法的结果。结果 复发时间在术后１年内，首次手术时ＡＦＰ〉１０００μｇ／Ｌ肿瘤直径〉５ｃｍ，门静脉有癌栓，外科切缘为０及术前行肝动脉插管化疗者等６大因素直接影响复发的预后，同时发现，复发肿瘤可行再次切     

大肝癌的外科治疗体会

目的　探讨手术切除大肝癌的可行性和安全性。方法　回顾性分析总结我院近 10年施行手术切除的 78例大肝癌的资料 ,并与同期手术治疗的 2 7例小肝癌进行比较。结果　大肝癌组施行的手术切除范围、术中失血量显著大于小肝癌组 ,手术时间亦明显长于小肝癌 ,因而并发症率也高 (P <0 .0 5 ) ,但两组间的死亡率并无显著差别 (P >0 .0 5 )。结论　大肝癌应积极地进行手术切除。经过仔细地选择病例 ,手术切除是安全可行的。     

Efficacy of anatomic resection vs nonanatomic resection for small nodular hepatocellular carcinoma based on gross classification

Background/Purpose  It has been reported that anatomic resection may be preferable to nonanatomic resection for small hepatocellular carcinomas (HCCs), by reducing socalled “micrometastases” (portal venous tumor extension and intrahepatic metastases). Nonanatomic resection or ablation has also been used as therapy for small HCCs. We studied the effectiveness of anatomic resection for small nodular HCCs, especially from the viewpoints of tumor size and gross classification. Methods  A retrospective cohort study was performed in 116 consecutive patients who underwent curative hepatic resection for HCCs 3 cm or smaller and with three or fewer nodules. The outcome of anatomic resection (including segmentectomy, sectoriectomy, and hemihepatectomy) was compared to that of nonanatomic partial hepatectomy. Results  The group that underwent anatomic resection (n = 52) had relatively better overall survival and significantly better recurrence-free survival than those with nonanatomic resection (n = 64). On Cox multivariate analysis, however, liver function was more closely associated with survival. The effect of anatomic resection was more prominent in the subgroup with the nonboundary type nodules (single nodular type with extranodular growth, confluent multinodular type, and invasive type) than in the subgroup with the boundary type (vaguely nodular and single nodular type). Micrometastases in the nonboundary type were found further from the main tumor (9.5 ± 6.2 mm) than those in the boundary type (within 3.1 +-1.4 mm). Conclusions  In patients with HCC nodules equal to or less than 3 cm and with the nonboundary type, anatomic resection should be employed to the extent that liver function allows, because this procedure would be more favorable than nonanatomic resection in eradicating micrometastases that have extended away from the tumor’s margin.     

肝癌切除术后并发症的多元回归分析

目的研宛与肝癌切除术后并发症发生有关的因素，并探讨减少肝癌切除术后并发症的技术要点。方法回顾性总结1988年6月至2005年4月间连续施行的378例肝癌切除病例，采用单因素分析和多元退步回归模型分析与肝癌切除术后并发症有关的因素。结果肝癌切除术后总的并发症发生率为17．7％，手术死亡率为1．3％。单因素分析显示，年龄、肝门阻断、出血量以及术中输血等4项指标与并发症发生有关。多元逐步回归分析显示年龄、肝门阻断和术中输血这3项指标是决定肝癌切除术后并发症发生的独立的危险因素。结论降低肝癌切除术后并发症发生率的关键在于术中有效地控制出血厦输血量，同时对伴存肝硬化的病人应尽量缩短肝门阻断时间。     

Left-hand-assisted laparoscopic resection of hepatocellular carcinoma in an accessory liver

We report a left-hand-assisted laparoscopic resection of hepatocellular carcinoma that developed in an accessory liver in a 47-year-old man. Preoperative assessment of the location of the tumor and the feeder vessels by combined selective angiography and computed tomography studies predicted the feasibility of laparoscopic procedures for complete removal of the tumor. In an attempt to avoid direct contact of the tumor capsule with rigid instruments during the operation, left-hand-assisted procedures were attempted. The encapsulated mass, 6 × 5 × 3 cm in size, was located on the posterior side of the left diaphragm, and a thin stalk between the tumor and the margin of the left lateral segment of the liver proper was recognized. Hand-assisted procedures ensured the complete mobilization of the lesion with an adequate margin, without any unexpected capsular tear. Left-hand-assisted laparoscopic procedures would be feasible for the easy and safe resection of localized hepatocellular carcinoma developing in an accessory liver. Received: November 13, 2000 / Accepted: March 7, 2001