原发性肝癌自发性破裂出血的治疗

目的 评价原发性肝癌自发性破裂出血的治疗方法。方法 对1991年～2001年我院收治的24例原发性肝癌自发性破裂出血患者进行回顾性总结分析。结果 急诊行肝癌切除术17例，填塞止血3例，肝动脉结扎 填塞止血2例，肝动脉结扎 缝合止血1例，保守治疗1例。1例死于失血性休克，2例于术后24h内死于MODS。随诊21例，术后生存小于3个月4例，小于6个月4例，小于12个月7例，12～24个月2例，24～36个月2例，大于36个月2例。随诊患者最终死亡原因：肝癌复发和转移、肝昏迷、上消化道出血和肝肾综合征。结论 肝叶切除和肝脏局部切除不但可以有效止血，而且可以切除肿瘤，部分病例可以达到根治的目的，是首选的方法。     

肝癌自发破裂出血的诊断与治疗

目的：总结肝癌自发破裂出血的诊断体会。临床资料：共４０例，其中合并肝硬变３４例，突发上腹或右上腹痛３６例，血腹２５例。治疗方法：经肝动脉化疗栓塞１５例，肝动脉结扎３例，缝合及填塞止血８例，微波凝固３例，一期肝切除６例，保守治疗５例，死亡９例（２２．５％）。结论：肝癌自发破裂出血治疗方法的选择及远期疗效取决于：①早期诊断，②即刻支持治疗，③早期非手术介入治疗（ＣＡＥ），④可切除病例，适时积极手术。     

肝切除术治疗肝癌破裂出血13例

肝癌破裂出血是肝癌病人的一种严重并发症,肿瘤常属进展期,预后较差。止血多采用肝动脉结扎或填塞缝扎等措施。我院1993年1月至1997年12月对肝癌破裂出血部分病例进行肝癌切除术,取得满意疗效,现报告如下。临床资料1.一般资料:我院1993年1月至1997年12月收治肝癌破裂出血病人41例,保守治疗9例,32例行急诊手术探查,其中11例行肝癌切除术,21例未能切除肿瘤而行缝扎、肝动脉结扎等止血。2例经     

肝癌脑转移瘤破裂出血一例报道

病人,男,53岁。右肝癌术后2年,肝内多处复发伴肺部多发转移,于2004年12月15日入院。2年内多次在我院行TAE及PEI治疗肝脏复发灶。本次入院为第10次,入院时一般情况尚可,AFP>1 000μg/L,CEA、CA19-9阴性。胸片提示两肺野可见多发小结节样密度增高影,大小不一,边缘稍模糊。诊断为两肺转移瘤(与之前胸片相比病灶增多增大)。CT提示为:肝癌术后多发复发灶+TACE后表现,肝硬化。放射性核素骨显像未见明确骨转移灶。本次住院后仅行护肝、支持等内科治疗。2005年01月09日晨起出现头昏、左侧头痛、右侧肢体无力,并出现恶心、呕吐,体检发现右侧…     

肝癌自发性破裂出血56例诊治体会

肝癌自发性破裂出血是肝癌常见的严重并发症之一 ,其发病急 ,病情险恶 ,治疗困难 ,预后较差。我院自 1 983年 8月至1 999年 8月共收治 56例 ,男 48例 ,女 8例 ,年龄 8～ 81岁 ,平均年龄 6 6 .6岁 ,其中 30～ 59岁 40例。腹痛 52例 ,有肝炎、肝硬变者 1 8例 ;全部患者均有不同程度贫血及血压降低 ,Ｈｂ 5～ 9ｇ/Ｌ ,2 0例收缩压低于 80ｍｍＨｇ( 1 0 .6ｋＰａ) ,42例患者行肝功能检查 ,1 6例正常 ,余 2 6例肝功能有不同程度损害。 36例经剖腹探查及病理检查证实为肝癌 ,余 2 0例行Ｂ超、ＡＦＰ、ＣＴ及肝穿刺活检证实为肝癌。 48例行腹腔诊断…     

18例肝癌自发性破裂出血治疗体会

目的探讨原发性肝癌自发破裂出血治疗方式的选择及价值。方法回顾分析2013年2月至2016年2月我院收治的18例肝癌自发性破裂出血患者的临床资料。结果所有患者常规给予抗休克输血止血治疗,11例行急诊肝切除术,术后均康复出院;5例行单纯介入治疗,其中4例好转出院,1例死亡;内科保守治疗2例,1例好转,1例死亡。结论对于有急诊肝切除指征的病例,应首选急诊手术,对于一般情况差、瘤体过大、肝功能失代偿及不能行肝切除术患者首选急诊介入止血,介入术后选择性肝切除术被认为是肝癌破裂出血患者的有效治疗策略,保守治疗效果差。     

原发性肝癌自发性破裂腹腔内出血53例诊治体会

目的探讨原发性肝癌自发性破裂腹腔内出血的临床特点和手术治疗方法。方法回顾性分析我院1998～2007年收治的53例经手术证实的原发性肝癌自发性破裂腹腔内出血患者的临床资料,结合文献复习进行讨论。结果53例患者均以突发性腹痛为首发症状,有前期症状者33例,无症状者20例;有外伤史者（左上腹或季肋区）6例;有腹膜炎体征46例,腹腔穿刺抽出不凝血41例,合并休克29例。术前误诊16例。行急诊手术48例,施行肝切除33例。术后肝功能不全34例,其中3例死于肝功能衰竭。术后生存3d～78个月,平均34．6个月。结论原发性肝癌自发性破裂腹腔内出血多以腹痛为首发,常以血性腹膜炎表现为特点,术前误诊率较高;手术方式根据病变位置、大小,肿瘤是否局限、转移和肝硬变程度决定。术后近期死亡原因主要是肝功能衰竭,远期死亡原因主要是复发转移。     

Brain metastases from hepatocellular carcinoma. A case report

Brain metastasis from hepatocarcinoma are a decidedly rare occurrence in countries where this pathology is most frequent. The authors describe a case of metastases from hepatocellular carcinoma in a patient suffering from post-HBV hepatic cirrhosis with hemorrhagic onset. The "stroke-like" presentation of the cerebral localization of the disease can be explained by both the important vascularization of the tumor and the frequent hemocoagulative alterations caused by the cirrhosis. The importance of diagnostic neuroradiology is briefly addressed, with reference to the fundamental role played by MRI. Surgery of these lesions does not present any particular technical problems as long as they are located in accessible areas and the patient's general and neurological conditions allow it. Postoperative radiotherapy seems to improve the quality and quantity of residual life, although the number of patients described in the literature is too small to draw any definite conclusion. Promising molecular biology studies are under way to evaluate the role of oncosuppresor gene expression in hepatocarcinogenesis and in the way the disease spreads.     

Spontaneous regression of lung metastases in hepatocellular carcinoma: A case report

IntroductionSpontaneous regression of hepatocellular carcinoma (HCC) is a rare condition. However, although there have been multiple reports of spontaneous regression, the definitive pathogenic mechanism of this phenomenon is still unclear.Case presentationWe encountered a case of a 78-year-old man who was undergoing dialysis for end-stage kidney disease with hepatitis C virus-associated chronic hepatitis presenting with HCC. The patient had previously undergone right lobectomy of the liver, but the cancer recurred with multiple lung metastases after 5 months. Approximately 13 months after the initial diagnosis of recurrence, the lung metastases decreased in size and eventually resolved without any anticancer therapy. The patient remains alive for over 41 months after recurrence.DiscussionBased on our case and literature, Hypoxia with hypotension due to hemodialysis can reduce the blood and oxygen supply of the body, which may lead to the spontaneous regression of the metastatic tumors.ConclusionWe herein reported a case of spontaneous regression of HCC undergoing dialysis.     

A case report of renal pelvic squamous cell carcinoma

We describe a case of a 75-year-old woman with squamous cell carcinoma in the right renal pelvis accompanied by multiple dysplasia in the upper urinary tract. Though it is difficult to make a preoperative diagnosis of squamous cell carcinoma, lavage cytology is particularly valuable. Renal arteriography and cross-sectional imaging are also useful to assess an accurate stage. We postulate that severe dysplasia could be a precursor of squamous cell carcinoma as well as transitional cell carcinoma.     

胸腺癌脊柱转移1例报道

胸腺癌是一种少见的肿瘤,约占全身肿瘤的0.2%～1.5%。其侵袭程度很高,早期即发生转移,胸外常转移至肝、肾、骨等,但脊柱转移极少,国内未见报道。我院1961年2月至1997年10月收治并确诊胸腺癌患者仅14例。我科近来收治1例胸腺癌颈胸椎转移病例,现报告如下。     

Skull metastasis of hepatocellular carcinoma: case report

We report a case of skull metastasis from a hepatocellular carcinoma (HCC). A 68-year-old male with hepatitis C virus-associated cirrhosis and HCC presented with painless subcutaneous mass in the left frontotemporal region. Radiologically, skull X-ray showed an osteolytic lesion, and non-contrast CT displayed a hyperdense tumor that homogeneously enhanced on contrast CT. Cerebral angiography demonstrated a hypervascular mass with the feeding arteries from the external carotid artery. The tumor was shown as an iso-intensity mass with flow voids on T1WI, as iso- to hypo- intensity on T2WI and FLAIR images, and as hypo-intensity on DWI. The lesion was markedly enhanced by Gd-DTPA. Previous reports have described a low incidence of skull metastasis in HCC patients. However, the incidence is gradually increasing due to the prolonged survival rates of HCC patients, indicating the significance of the disease as a differencial diagnosis for skull tumors. Recent reports describe characteristic MRI findings of skull metastasis from HCC (hypointensity on T2WI with flow void); however, owing to the rarity of this disease, more studies are needed to establish the typical MRI pathognomonic findings.     

Vesicorectal fistula caused by pelvic metastasis of penile cancer: a case report

A 65-year-old man was referred to our hospital complaining of glans induration. Tumor biopsy revealed squamous cell carcinoma. Although he was given radiation therapy and subcutaneous injection therapy of bleomycin, viable cancer cells remained. Then he was given combination chemotherapy of bleomycin and cisplatin, and paint therapy of bleomycin ointment. Local recurrence with a cauliflower-like tumor occurred five years after the chemotherapy. Then we performed total penectomy and reconstructive surgery of penis. Five years later, discharge of urine from anal appeared. Computerized tomography of pelvis demonstrated a mass 3 cm in diameter in the anterior portion of anal and cystogram demonstrated a vesicorectal fistula. We tried to perform fistulectomy, but foiled because of large fistula. Then we inserted a urethral catheter, which resulted in obstruction of fistula by its balloon, and we made a cystostomy for securing urinary tract. Pathological examination of tissue around the fistula revealed squamous cell carcinoma. His quality of life was improved, but his general condition became worse gradually and he died of cancer.     

Primary hepatocellular carcinoma in pregnancy. A case report

A case of primary hepatocellular carcinoma (HCC) in a 17-year-old pregnant primigravida diagnosed during the 32nd week of pregnancy is presented. A live infant was delivered after induction of labour during the 33rd week. The mother, although still alive 3 months postpartum, had ongoing spread of the malignancy. Only 7 cases of primary liver cancer in pregnancy have been reported to date, with 100% maternal mortality and only 3 live infants. The literature and the diagnosis and management are discussed.     

Spontaneous necrosis of hepatocellular carcinoma: a case report

BACKGROUND: Spontaneous regression of a malignant tumor is a rare phenomenon. So far, 13 cases of spontaneous regression of hepatocellular carcinoma (HCC) have been described in the English literature. We report a case of HCC, with spontaneous complete necrosis demonstrated by histological examination. METHODS: A 73-year-old male was admitted to our hospital complaining of general fatigue. CT and US revealed a huge mass measuring 9.5 cm at the left lobe. Angiographies showed hypovascular tumor stains. The levels of alpha-fetoprotein (AFP) and PIVKA-2 on admission were high, at 55 ng/ml and 62,300 mAU/ml, respectively. We diagnosed hypovascular HCC and performed a left lobectomy on October 16, 2000. RESULTS: In the histological examination, no viable cells were found. The levels of AFP and PIVKA-2 had already decreased to 14 ng/ml and 1,420 mAU/ml, before laparotomy. CONCLUSION: Changes in tumor markers and histological findings reveal that this phenomenon occurred without specific treatment.