原发性肝癌根治性切除术后不同时间TACE对血清肿瘤标志物及复发风险的影响

目的 观察原发性肝癌根治术后不同时间肝动脉介入化疗栓塞术(TACE)对血清肿瘤标志物和复发风险的影响。方法 选取2016年3月—2019年10月亳州市中医院接受根治性切除术治疗的65例原发性肝癌患者，使用随机数字表法分为观察组(33例)和对照组(32例)。两组均在根治性切除术后进行TACE治疗，其中观察组术后4周进行TACE治疗，对照组术后8～12周进行TACE治疗，两组第1次TACE治疗后间隔4周后接受第2次治疗。比较两组术后并发症及随访3年肝内复发率。结果 治疗前，两组癌胚抗原(CEA)分别为(26.63±5.19)ng/mL、(25.48±4.03)ng/mL,两组甲胎蛋白(AFP)分别为(84.39±8.61)μg/L、(85.52±9.36)μg/L,两组糖类抗原199(CA199)分别为(81.06±7.93)U/L、(80.54±6.68)U/L,两组CEA、AFP、CA199无明显差异(P>0.05);治疗后，两组CEA分别为(4.13±0.72)ng/mL、(6.18±0.95)ng/mL,两组AFP分别为(16.28±3.65)μg/L、(24.97±5.14...     

血清甲胎蛋白在人工肝治疗乙型肝炎相关慢加急性肝衰竭预后评估中的价值

目的探讨甲胎蛋白(AFP)水平在人工肝治疗乙型肝炎相关慢加急性肝衰竭(HBV-ACLF)患者生存的价值。方法回顾性收集我科人工肝血浆置换治疗HBV-ACLF患者人工肝前的临床检测指标,对比血清AFP水平在人工肝后30、90、180 d生存组与死亡组差异;绘制受试者工作特征曲线(ROC曲线),计算AFP对人工肝术后30、90、180 d生存预测的敏感度、特异度;以中位数将AFP分为高AFP组及低AFP组,分析APF与术后30、90、180 d生存预测价值。结果本研究共计纳入93例患者,30、90、180 d生存组的的AFP分别为(231.0±286.2)ng/ml、(237.69±297)ng/ml、(229.44±286.46)ng/ml,死亡组AFP分别为(76.4±104.7)ng/ml、(103.13±116.99)ng/ml、(136.34±2.9.29)ng/ml,死亡组AFP均显著低于对应生存组(P<0.05);ROC曲线分析提示人工肝术后30、90、180 d的ROC曲线下面积(AUC)和95%可信区间分别为0.739(0.611~0.867),0.675(0.550~0.801),0.653(0.524~0.781)。血清AFP中位数为110 ng/ml,生存分析发现高AFP组人工肝术后30 d(P=0.01)、90 d(P=0.04)及180 d(P=0.03)生存时间均显著高于低AFP组患者。结论血清AFP可作为HBV-ACLF患者人工肝后生存情况的预测因子,临床价值有待进一步扩大样本量验证。     

血清高尔基体蛋白73诊断原发性肝癌价值探讨

目的探讨高尔基体蛋白73（GP73）诊断肝癌的价值。方法在肝癌107例、肝硬化53例、肝衰竭患者40例和健康人34例,采用ELISA法检测血清GP73浓度,采用ROC曲线寻找GP73诊断肝癌的最佳截断点,并与AFP进行比较,以评价GP73诊断肝癌的价值。结果原发性肝癌、肝硬化和慢性肝衰竭患者血清GP73水平分别为123.5±22.4ng/ml、108.9±30.3ng/ml和130.3±45.6ng/ml,均显著高于健康对照人群（44.1±38.9ng/ml,P〈0.05）;原发性肝癌、肝硬化和慢性肝衰竭患者血清AFP水平分别为236.6±205.3ng/ml、5.3±5.56ng/ml和53.9±40.40 ng/ml;选择血清GP73最佳截断点为77.4ng/ml,其诊断原发性肝癌的灵敏度为89.6%,特异度为100%,AFP的最佳截断点为35.4ng/ml,其诊断原发性肝癌的灵敏度为64.2%,特异度为100%;原发性肝癌患者血清GP73水平在不同年龄、性别、Edmondson分级和结节数目多寡之间无显著性相差,而在不同肿瘤大小、TNM分期和是否合并肝硬化方面均有显著性差异（P＜0.05）。结论血清GP73诊断肝癌的灵敏度优于AFP,尤其在AFP阴性患者诊断中有一定的意义。     

不同AFP水平下血清IL-1与肝癌根治术后早期复发和预后的关系

目的研究IL-17在不同AFP水平下的HBV相关肝细胞癌(HCC)中的表达情况以及其与HCC根治术后复发和预后的关系。方法收集新疆医科大学附属肿瘤医院2013年1月-2014年12月收治的HBV相关HCC行根治切除术的连续病例167例,另外选取肝血管瘤患者115例(其中HBV携带者83例)作为对照组。采用ELISA法检测167例HBV相关HCC血清中IL-17表达,采用电化学发光法检测血清AFP浓度,并分析IL-17的表达与不同AFP水平的关联性及其与HBV相关HCC患者根治切除术后复发和生存的关系。计数资料组间比较采用χ2检验,生存分析采用Kaplan-Meier相关性分析、Log-rank检验以及Cox比例风险模型。结果将HBV相关HCC患者以血清AFP水平分为2组,AFP<400 ng/ml组IL-17的阳性表达率为50.9%(58/114),AFP≥400 ng/ml组为34.0%(18/53),2组比较差异有统计学意义(χ~2=8.11,P=0.002)。AFP<400 ng/ml组和AFP≥400 ng/ml组患者术后无瘤生存期(34.1个月vs 13.4个月)、总体生存期(84.2个月vs 57.4个月)、1年内肿瘤复发率(28.9%vs 50.9%)比较差异均有统计学意义(χ~2值分别为10.34、3.13、10.89,P值均<0.05)。Kaplan-Meier分析发现,AFP<400 ng/ml的HBV相关HCC患者,IL-17阳性表达组术后1年复发率高于阴性表达组,无瘤生存期、总生存期均显著低于低表达组(χ2值分别为7.350、3.814、9.744,P值均<0.05)。Cox模型分析结果显示,IL-17阳性表达、血管癌栓、组织分化程度是影响HCC患者预后的相关因素(P值均<0.05)。结论 AFP<400 ng/ml的HBV相关HCC患者中IL-17阳性表达预示着早期复发和预后不良。     

外周血甲胎蛋白mRNA定量与裸鼠肝癌术后复发转移的关系

目的 研究外周血中胎蛋白信使核糖核酸(AFP mRNA)水平与原发性肝癌根治性切除术后复发转移的关系。方法 裸鼠肝内原位接种裸鼠人肝癌转移模型LCI-D20肿瘤组织,接种后第10天切除移植瘤,切除后第2天用不同剂量干扰素α-1b(IFNα-1b )治疗,治疗35 d后取外周血1 ml,用TaqMan实时定量逆转录－聚合酶链反应(RT-PCR)技术检测AFP mRNA水平,同时观察肿瘤复发转移情况。结果 对照组裸鼠术后肝内复发率和肺转移率均为100%(12/12),外周血AFP mRNA阳性率为100%。小剂量IFNα-1b治疗组肝内复发率62.5%(5/8),复发瘤体积小于对照组(25 mm~3±2mm~3对1143mm~3±3mm~3,t=9.27,P＜0.01),无肺转移,外周血AFP mRNA阳性率87.5%(7/8),水平低于对照组[(85±6)copies/μg对(955±2)copies/μg,t＝4.33,P＜0.01)。大剂量IFNα-1b治疗组肝内复发率为12.5%(1/8),体积仅0.5mm~,无肺转移,外周血AFP mRNA均阴性(x~2=11.67,P＜0.01)。结论 外周血AFP mRNA可作反映肝癌复发转移的敏感指标,TaqMan实时定量RT-PCR技术检测循环血肝癌细胞灵敏、简便、精确度高。     

腹腔镜下复发肝癌切除术的临床效果观察

目的观察腹腔镜下复发肝癌切除术的临床疗效。方法选取该院2012-04~2015-10收治的34例复发肝癌患者为研究对象,按手术方式不同分为腹腔镜组和开腹组,每组17例。腹腔镜组采用腹腔镜下肝切除术,开腹组采用开放式肝切除术,比较两组的术中、术后情况以及术后1年复发率。结果腹腔镜组的手术时间、术中出血量、手术切口长度、术后下床时间、术后疼痛指数分别为(93.28±46.45)min、(122.68±52.74)ml、(6.34±1.82)cm、(3.44±1.26)d、(4.52±2.39)分低于或少于开腹组的(126.43±39.13)min、(237.81±76.39)ml、(21.43±2.25)cm、(8.25±2.37)d、(6.71±1.85)分(P0.05)。结论腹腔镜下复发肝癌切除术具有创伤小、出血量少、术后恢复快等优点,可以作为复发肝癌的首选治疗方式。     

外周血甲胎蛋白mRNA对肝癌诊断价值的探讨

目的 探讨外周血甲胎蛋白(AFP)基因在原发性肝癌(HCC)早期诊断和鉴别诊断中的临床价值.方法 从肝病患者外周血中制备RNA,以巢式聚合酶链反应(RT.PCR)扩增AFP基因.测定20份肝癌、癌周和远癌组织中总RNA浓度.结果 远癌和癌周组织RNA浓度明显高于癌灶组织(P<0.05),癌组织中AFP基因检出率均为100%;肝癌患者外周血中AFP基因的检出率为53.7%,明显高于肝硬化、慢性肝炎、急性肝炎和肝外肿瘤组患者(P<0.01);在Ⅰ、Ⅱ和Ⅲ期肝癌中,AFP基因阳性率分别为33.3%、26.3%和71.8%;肝内有无转移的肝癌组间存在明显差异(P<0.05),尤其在伴有肝外远处转移的肝癌中,AFP基因全数阳性(100%);在AFP<200 ng/ml肝癌中,AFP基因阳性率为50.0%;与肝癌大小间未见统计学差异(P0.05).结论 分析外周血中AFP基因有助于肝癌的诊断、肝癌远处转移判别及肝癌术后复发的监测.     

标准残肝体积对肝脏储备功能的评价

目的:探讨肝脏切除术后标准残肝体积(standard remnant liver volume,SRLV)大小与 患者术后肝功能代偿不全的关系.方法:对我院2007-03/2008-02收治的75例因肝癌行肝切除术的患者进行研究,术前采用CT测定患者的全肝体积,术中被切除的肝脏组织的体积由排水法测定,全肝体积与术中切除肝脏组织体积之差除以患者的体表面积即为标准残肝体积.根据术后患者肝功能代偿状况进行分组,比较不同组间标准残肝体积均数的差异;并根据标准残肝体积再分组,比较组间术后发生肝功能中、重度代偿不全发生率的差异.结果:术后肝功能轻度代偿不全组60例,中度代偿不全组12例,重度代偿不全组3例(因重度代偿不全组例数过少,纳入中度代偿不全组进行统计分析).术后肝功能轻度代偿不全组标准残肝体积均值为545±93mL/m2,而术后肝功能中、重度代偿不全组仅为398±82mL/m2,两者间比较有统计学差异(P<0.001),术后发生肝功能中、重度代偿不全患者标准残肝体积较小.按标准残肝体积416mL/m2为界将所有患者分为两组,A组SRLV≤416mL/m2,而B组SRLV>416mL/m2,两组术后肝功能中、重度代偿不全发生率分别为68.8%和6.8%,组间差异有显著性意义(P<0.001),SRLV≤416mL/m2术后肝功能中、重度代偿不全发生率较高.结论:标准残肝体积是评估肝切除术患者肝脏储备功能的有效且简便的方法,对预测患者术后发生肝功能损害的程度及避免患者术后发生肝功能衰竭有重要的临床指导作用.     

血清基质金属蛋白酶-2与肝细胞癌根治性切除术后转移复发的关系

目的检测肝细胞癌(HCC)患者术前血清基质金属蛋白酶-2(MMP-2)水平以确定其与HCC根治性切除术后转移复发的关系。方法采用Cox风险分析模型对影响预后的临床指标进行分析以确定影响HCC切除术后生存时间的临床指标。同时,应用ELISA方法检测HCC患者术前血清MMP-2水平及northernbolt方法对24例相应肿瘤组织MMP-2mRNA表达水平进行定量分析。结果Cox风险分析模型显示肿瘤大小及肿瘤是否存在肝内播散是影响HCC切除术后生存时间的显著因素(P＝0.022和P＝0.040),并以此划分为高和低转移复发倾向组。根治性切除术后高转移复发倾向组HCC患者术前血清MMP-2显著高于根治切除术后低转移复发倾向组［(26.39±2.64)ng/ml对(24.86±1.95)ng/ml,P＜0.05］。非根治性切除组HCC患者术前血清MMP-2水平也显著高于根治性切除组HCC患者,(29.43±3.12)ng/ml对(25.72±2.45)ng/ml,P＜0.01。Northernblot显示,HCC患者血清MMP-2水平变化与其对应肿瘤组织MMP-2mRNA表达变化相一致。结论HCC患者术前血清MMP-2水平能反映HCC根治性切除术后转移复发倾向。HCC患者血清MMP-2水平升高是HCC细胞高表达MMP-2mRNA的结果。     

血清甲胎蛋白异质体鉴别原发性肝癌与继发性肝癌的研究

我们利用亲和层析法和放射免疫分析法对原发性肝癌和继发性肝癌患者血清中的甲胎蛋白(AFP)与刀豆蛋白(简称ConA)的结合特征进行了研究,旨在探讨二种肝癌之间的鉴别。血清AFP浓度在11例继发性肝癌中有6例超过400ng/ml,而42例原发性肝癌中有7例低于400ng/ml,提示AFP总量测定有一定的局限性。42例原发性肝癌患者的ConA非结合型AFP(Con A non-reactive AF     

Multiple necrotic nodules of the liver simulating liver metastasis

A 70‐year‐old man was referred to our hospital due to anemia and elevated serum tumor marker levels. He had advanced colon cancer, and hepatic lesions were found incidentally. On ultrasonography (US) and computed tomography (CT), the hepatic lesions had a maximum diameter of 20 mm and were located in Couinaud's segments V, VI, VII, and VIII, which suggested liver metastasis. On early‐ and late‐phase CT during hepatic arteriography (CTHA), all of the lesions had rim enhancement. On early‐phase CT during arterioportography (CTAP), all of the lesions were seen as nodules with an irregular perfusion defect, and on late‐phase CTAP, all the lesions gradually became iso‐dense, and their shape and size changed. Based on the CTAP findings, these lesions were thought to be fibrotic tumors. Partial resection of the liver (including the lesions in Couinaud's segments V and VIII) was done. Histological examination revealed that the lesions were necrotic nodules. Thus, CT angiography (CTHA and CTAP) was useful for identifying necrotic nodules, because their appearance on this modality is different from that of liver metastases.     

Carcinosarcoma of the liver

Herein we present a 73-year-old man with primary carcinosarcoma of the liver, a rare malignant tumor of the liver. The case was followed up due to HBV-related liver cirrhosis. Regular check-up by ultrasound demonstrated a hyperechoic tumor in the left lobe of the liver, and he was referred and admitted to our hospital. Dynamic CT studies revealed a mostly hypoenhancing hepatic mass with a peripheral ring enhancement. Surgical resection was performed, and the resected tumor was macroscopically a simple nodular type, 3 cm in diameter, with a dense fibrous capsule. Microscopically, undifferentiated cells were dominant in the tumor, while moderately differentiated hepatocellular carcinoma (HCC) were also observed. A transitional zone was noted between the undifferentiated tumor and HCC. Tumor tissue with adenocarcinoma, osteosarcoma and chondrosarcoma were also detected. Immunohistochemical studies demonstrated that tumor cells were HepPar 1 positive in hepatocellular carcinoma, and CK19 and partly CK7 positive in adenocarcinoma. Moreover, CD56, chromogranin A and c-kit were occasionally positive in undifferentiated tumor cells. The diagnosis of carcinosarcoma was made based on the concomitant presence of HCC and sarcomatous components, yet it is noteworthy that various types of tumor cells were observed.     

Tuberculoma of the liver

During the period 1973-76 2 patients, neither immigrants, were operated on and found to have tuberculoma of the liver. Both were successfully treated. Tuberculoma of the liver is an uncommon condition and is rarely encountered as a surgical problem. It can, however, present a surgical challenge as it must be distinguished from the more common types of right upper quandrant abdominal lesions such as biliary, gastroduodenal and other hepatic diseases. The occurrence of a tuberculoma of the liver without coexistent tuberculosis elsewhere in the body is extremely rare. Its presence in association with other tuberculous foci, whilst uncommon, has been recorded on a number of occasions.     

Xenotransplantation of the liver

Xenotransplantation of the liver, in its broadest conception, might involve the transplantation of an intact organ or xenogeneic hepatocytes, or the use of an intact xenogeneic liver or cells as an ex vivo "device." The indications for xenotransplantation include not only hepatic failure but also, potentially, the treatment of metabolic diseases. The hurdles to xenotransplantation include immune, physiologic, and infectious complications. New information and progress in experimental systems are bringing xenotransplantation closer to clinical application.