结直肠肿瘤生物样本库质量控制体系建立的经验与体会

目的通过创建结直肠肿瘤组织样本库质量控制体系,充分保护和合理利用结直肠肿瘤标本资源,为临床和科学研究者提供质量合格的结直肠肿瘤标本,促进结直肠肿瘤的研究。方法建立严格的结直肠肿瘤组织生物样本库质量控制体系,规范收集手术切除后的肿瘤组织,包括肿瘤、瘤旁和切缘远端正常组织以及术前、术后的外周血血清/血浆标本。建立一套完整的结直肠肿瘤组织提取、储存操作流程,制定质量控制方案,建立符合国际规范的结直肠肿瘤组织生物样本库及信息管理系统,提供临床样本资源。结果标本库现保存有完整临床资料及随访资料的结直肠肿瘤组织标本1600例。其中恶性肿瘤1225例,良性肿瘤275例。包括肿瘤组织、癌旁组织、远端正常组织标本以及术前、术后血液标本。完成了标本库信息数据管理软件的开发工作,对所收集标本的流行病学及临床资料信息录入计算机归档管理。结论初步建立了具有一定规模的肿瘤标本资源库,完善了结直肠肿瘤生物样本库质量控制体系,形成了一整套肿瘤组织标本库的建设及管理方法,为相关的结直肠肿瘤研究提供了服务平台。     

肝脏的罕见肿瘤——肝脏错构瘤

肝脏错构瘤（liver hamartoma）是肝脏少见的良性肿瘤，本病多见于10岁以下小儿，85％以上的病例发病年龄在2岁以内，国外文献累积报道约200余例，国内报道最多一组只有12例，且多为个案报道，由于发病隐匿，无特异性，误诊率比较高，故对其应该引起重视。     

生物样本库在结直肠肿瘤转化中的研究价值

目的:分析生物样本库在结直肠肿瘤转化中的研究价值.方法:将结直肠肿瘤患者73例按入院顺序分为对照组36例和观察组37例.对照组患者接受常规转化评估,观察组患者接受生物样本库评估,比较2组判断结直肠肿瘤转化准确率.结果:观察组患者结直肠肿瘤转化判断准确率高于对照组(P<0.05).结论:生物样本库能提升结直肠肿瘤转化中的...     

胆道系统肿瘤标本库的建立与分析

目的 建立胆道系统肿瘤血液及组织标本库,为进一步开展胆道肿瘤研究提供参考.方法 选取2010年3月至9月我院肝胆外科以胆道肿瘤为主要诊断而行手术切除的患者标本37例,留取血浆、血清及组织标本,制作石蜡包块并行常规病理组织学鉴定,并使用 Trizol 试剂提取总 RNA及基因组DNA.结果 37例标本中胆管癌18例,胆囊癌19例.两组间在性别、黄疸表现、是否合并胆道结石、能否根治性手术及近期生存时间存在差异.抽样检查显示77.8%的样本分子生物学指标稳定.结论 本实验建立的胆道肿瘤标本采集流程有效可行,临床资料收集完备,能够为今后胆道系统肿瘤的发生发展机制研究提供较好的标本资源.     

肝脏肿瘤射频原位灭活的研究进展

肝癌是常见的恶性肿瘤 ,肝脏切除是唯一可能治愈的治疗方法 ,但估计只有 5～ 1 5 %的 HCC或继发性肝癌适于手术切除。已接受手术切除的病人 ,仍有相当高的复发率。其 5年生存率只有 2 0～ 4 0 %。因此 ,临床上需要一种有效的能部分替代手术的肿瘤治疗技术。射频灭活 (Radiofreq     

门静脉高压症标本库的初步建立、质控及管理

目的 探索建立门静脉高压症(portal hypertension,PH)生物标本库及数据信息化管理方法和标准化操作流程,为PH基础与临床研究提供高质量的临床标本资源.方法 收集PH患者的血液、尿液、唾液、组织标本,将处理好的标本于-80℃冰箱保存,新鲜组织标本置于液氮保存,定期随机抽取标本进行质量控制.结果 现收集并...     

肝脏肿瘤的冷冻切除术

外科手术切除肝脏性恶性肿瘤是目前公认的使患者获得长期生存的治疗方法 [1 ] 。然而临床上仅 1/ 3的原发性肝癌和 10 %～ 2 0 %的转移性肝癌有手术切除的机会 ,因此 ,寻找具有适应证更广的有效治疗方法是当前的热点之一 [3] 。随着新的影像技术的发展和冷冻设备和临床应用 ,冷冻外科日益引人注意 [2 ] 。已有报道 [4 ] 经冷冻治疗的肝患者有 5 0 %～ 6 0 %的人生存长期达 2 4个月。低温冷冻破坏肿瘤细胞的机制有三 :首先 ,在降温的过程中 ,细胞逐渐失去生命活动必须的热量 ,各种代谢反应停止 ,生物膜结构破坏 ;冷冻使细胞内外的纯水结晶 ,…     

肝脏肿瘤局部消融技术的选择

肝脏肿瘤常见的有:原发性肝癌(primary livercancer,PLC)、继发性肝癌(secondary hepatic carcinoma)、转移性肝癌(metastatic hepatic carcinoma)、肝血管瘤(hemangioma of liver)等。原发性肝癌是我国常见的恶性肿瘤之一;肝脏也是体内其它部位     

肝脏少见肿瘤的CT诊断

目的：探讨CT增强扫描在肝脏少见肿瘤的诊断及治疗方案选择中的价值。方法：回顾性分析8例经手术及病理检查证实、2例经肝脏穿刺活检证实的肝脏少见肿瘤的CT增强表现特征，并对比分析相关的临床表现、实验室检查和手术所见。结果：病理组织学检查证实，本组10例中良性肿瘤3例、恶性肿瘤7例，CT增强扫描显示，5例为囊实性，5例为实质性；8例表现为不均匀强化，2例淋巴瘤无明显强化。CT可较准确地显示肿瘤与肝内血管的毗邻关系以及对肝邻近组织器官的推压与侵犯等，与手术所见一致。临床表现和实验室检查对肝脏少见肿瘤定性诊断价值不大，但有助于与肝细胞癌鉴别。结论：CT增强扫描对肝脏少见肿瘤定性诊断较困难，但结合临床表现与实验室检查仍有助于与肝细胞癌相鉴别；CT增强扫描可准确判断肿瘤的解剖部位及其对邻近组织器官侵犯的情况，从而帮助制定合理、详细的手术方案。     

胰腺神经内分泌肿瘤肝转移外科治疗

近年来胰腺神经内分泌肿瘤的发病率不断增加,肝转移是影响病人生活质量和长期生存的主要因素。对胰腺神经内分泌肿瘤肝转移应采取多学科协作治疗的原则。作为核心的外科治疗包括姑息性部分肝切除、根治性部分肝切除以及全肝切除肝移植等。不论是在控制致命性的神经内分泌症状方面还是在提高病人长期生存方面外科治疗均有不可替代的作用。     

Foreign-body granuloma mimicking an extrahepatically growing liver tumor: Report of a case

We herein describe a 74-year-old woman with a foreign-body granuloma mimicking a liver tumor. Imaging studies revealed a pedunculated left lobe mass in the setting of chronic liver disease. She had a past history of a cholecystectomy as well as a previous gynecological operation. A left lateral segmentectomy was performed because of the possibility of a rupture. The dissected specimen showed a foreign-body granuloma caused by gauze. We believe this case to be a very unique granuloma, which should be kept in mind whenever making a diagnosis of a liver tumor particularly in a patient with chronic liver disease, who has a past history of abdominal surgery.     

胃肠恶性肿瘤伴肝硬化门静脉高压症的外科治疗

目的总结肝硬化门静脉高压症合并胃肠肿瘤患者围手术期处理经验。方法对2000年1月至2005年7月收治的23例（17例胃肿瘤及6例结肠肿瘤）合并肝硬化门静脉高压症行手术治疗的胃肠肿瘤患者资料进行回顾性分析研究。结果本组23例患者，治愈17例，死亡6例，死因为MODS5例，急性肺栓塞1例，病死率为26．1％。死亡病例与肝功能分级有明显关系，ChildA级死亡1例（12．5％），B级死亡2例（22．2%），C级死亡3例（50％）。发生吻合口漏1例，胰尾血管出血1例，未发生残胃缺血。结论对合并有门静脉高压症的胃肠肿瘤患者，正确掌握其手术适应证和时机，加强围手术期处理，以降低病死率和并发症发生率。     

胃肠恶性肿瘤伴肝硬化门静脉高压症的外科治疗

目的总结肝硬化门静脉高压症合并胃肠肿瘤患者围手术期处理经验。方法对2000年1月至2005年7月收治的23例(17例胃肿瘤及6例结肠肿瘤)合并肝硬化门静脉高压症行手术治疗的胃肠肿瘤患者资料进行回顾性分析研究。结果本组23例患者,治愈17例,死亡6例,死因为MODS5例,急性肺栓塞1例,病死率为26.1%。死亡病例与肝功能分级有明显关系,ChildA级死亡1例(12.5%),B级死亡2例(22.2%),C级死亡3例(50%)。发生吻合口漏1例,胰尾血管出血1例,未发生残胃缺血。结论对合并有门静脉高压症的胃肠肿瘤患者,正确掌握其手术适应证和时机,加强围手术期处理,以降低病死率和并发症发生率。     

射频消融治疗肝肿瘤315例报告

目的总结1999年6月至2003年8月用射频消融(radiofrequencyablation,RFA)治疗315例肝肿瘤病人的病例资料,探索RFA治疗肝肿瘤近远期疗效。方法采用了一次定位、多点穿刺,RFA联合肝动脉栓塞(TAE)、选择性门静脉栓塞(SPVE)治疗直径5~13cm的大肝癌,及经皮经肺经膈肌RFA治疗膈顶部肝癌。结果总并发症发生率为5.1%,无一例住院期间死亡。AFP阳性的169例肝癌病人中,RFA后有124例(73.6%)明显降低,其中有95例(56.2%)转阴。半年生存率为89.5%,1年生存率为80.1%,18个月生存率为61.4%,24个月生存率为48.3%,>36个月生存率为35.6%。结论采用TAE、SPVE及RFA一次定位多点穿刺法治疗无手术切除指征的中晚期(含大肝癌)的病人,疗效明显,总并发症发生率低。     

Pediatric intrahepatic bile duct adenoma-rare liver tumor: A case report

BACKGROUND Intrahepatic bile duct adenoma(BDA) is one of the rarest of the rare benign tumors of the liver in the pediatric age group. It arises from the epithelial lining of intrahepatic bile ducts. The overall incidence of BDA is 1.3% of all primary benign liver tumors. Few case reports of this rare tumor occurring in adult population are present in the literature and to date, only one pediatric case has been reported worldwide.CASE SUMMARY An 18-month-old male child presented with chief complaints of mass per abdomen for 8 mo. Computerized tomography abdomen revealed a well-defined exophytic solid tumor arising from the posteroinferior margin of the right lobe of the liver with heterogenous enhancement and cystic changes, suggesting a suspicion of hepatoblastoma. Non-anatomical liver resection was done and a tumor of 10 cm × 9.5 cm was excised. Histopathology of the specimen was conclusive with the diagnosis of intrahepatic bile duct adenoma, which was further supported by immunohistochemistry panel testing. The post-operative period was uneventful. On follow-up, the child was doing well and had no postoperative complication.CONCLUSION Intrahepatic bile duct adenoma in children is very rare and to date only one case has been reported. This is the second pediatric case of intrahepatic bile duct adenoma in the world. Additionally this is the first ever case of such a large tumor presenting in a child.     

Hand-assisted laparoscopic management of liver tumors

Background Laparoscopy has clearly advanced the treatment of many diseases related to the liver and biliary tree. The addition of hand assistance can further facilitate minimally invasive liver surgery by providing tactile feedback, atraumatic and versatile retraction, finger-fracture parenchyma dissection, and more precise placement of probes and staplers. Methods Over a 7-year period, 28 patients with liver tumors underwent 31 hand-assisted laparoscopic operations at a tertiary care center. The candidates for hand-assisted laparoscopic resection were patients with lesions involving two hepatic segments or fewer located at the inferior edge of the liver (segments 5 and 6), or confined to the left lateral segment (segments 2 and 3). Ablation was reserved for patients with poor functional status or limited hepatic reserve, and hand-assistance was added for laparoscopic ablation of centrally located tumors (segments 7, 8, and 4a). Results The selection criteria were met by 52 patients, 6 of whom had benign lesions. The remaining 46 patients had malignant disease, and 15 of these patients (33%) were found to have extrahepatic disease: 11 at initial laparoscopy and 4 at hand-assisted abdominal exploration. Manual exploration also detected additional intrahepatic treatable lesions in two cases. A total of 19 patients (68%) had metastatic disease, and 3 (11%) had primary liver cancer. The most extensive resections were five left lateral segmentectomies. All margins were negative. The mean operative time was 2.75 h, and the mean blood loss was 230 ml. Two diaphragmatic injuries occurred during ablation of segment 8 lesions. Three cases were converted to open surgery because of adhesions. The mean hospital stay was 3.7 days. A group of 15 patients who had metastatic colorectal cancer treated with resection and/or ablation had a mean follow-up period of 24 months (range, 2–61 months) and a mean survival time of 36 months. Conclusions For selected patients, the hand-assisted technique can be applied safely and effectively to laparoscopic liver surgery and may identify the presence of previously undetectable intrahepatic or extrahepatic disease. Poster presentation at the 2006 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Scientific Session, April 26–29, 2006, Dallas, TX     

肝血管周上皮样细胞肿瘤超声表现1例

患者男,81岁,体检超声发现肝脏占位2周;慢性乙型病毒性肝炎20年,未经系统治疗。查体未见异常。实验室检查:乙肝病毒表面抗原(+)、乙肝病毒e抗体(+)、乙肝病毒核心抗体(+),肝功能及肿瘤标记物均未见明显异常。上腹部CT:肝脏S5段(右肝前叶下段)见3.9 cm×2.7 cm低密度团块,边界清晰,增强扫描动脉期明显不均匀强化,门静脉期及延迟期轻度强化;CT诊断:肝脏S5段实性团块,恶性可能性大。     

肝脏血管周上皮样细胞肿瘤临床分析

目的 提高对罕见的肝脏原发性肿瘤——肝脏血管周上皮样细胞肿瘤(PEComa)的诊疗水平.方法 采用文献检索收集1989 ～ 2013年间报道的包括北京大学人民医院1例在内资料齐全的原发性肝脏PEComa患者41例,总结其病例资料,对原发性肝脏PEComa的临床特点、影像学资料、病理特点、治疗及预后进行回顾性分析.结果 肝脏PEComa无特异性临床表现,影像学特征不易识别,主要依靠术后病理确诊.手术是目前公认的主要治疗方法.41例患者中34例为良性,7例为恶性,恶性者预后较差.结论 原发性肝脏PEComa是一种肝脏罕见肿瘤,应提高对其认识和诊疗水平,术后应长期密切随访.     

肝脏炎性肌纤维母细胞瘤

目的探讨肝脏炎性肌纤维母细胞瘤的临床病理特征、诊治和预后。方法总结了一例肝脏炎性肌纤维母细胞瘤病人的临床资料,并复习了国内外的文献,分析和归纳其临床表现、诊断和治疗。结果肝脏炎性肌纤维母细胞瘤的临床病理特征和预后如下:①常见于儿童和青少年;②临床症状常表现为贫血、发热、上腹部隐胀痛、体重下降等;③物理检查可见肝脏包块;④病理特征:该瘤由分化的肌纤维母细胞性梭形细胞组成,常伴大量浆细胞和(或)淋巴细胞浸润;⑤外科切除或肝移植后,预后佳,无复发。结论肝脏炎性肌纤维母细胞瘤有其特征性的临床表现,经手术切除后可治愈。