手术治疗原发性肝癌的临床分析

目的：探讨外科手术在治疗原发性肝癌方面的临床疗效。方法选取我院2011年1月~2013年12月收治的原发性肝癌患者86例,所有患者均采取外科手术治疗,回顾性分析其实验室检查指标、手术经过,并跟踪随访观察其临床预后情况。结果3例患者肝衰竭死亡,死亡率为3.4%,13例患者发生术后并发症,发生率约为15.1%。86例患者术后6个月、1年、1年6个月存活率分别为：97.7%、83.7%、77.9%。结论对于原发性肝癌患者行积极手术治疗,并根据患者情况选择针对性的手术方案,可有效提高手术的成功率及患者术后的存活率。但随访结果显示,总体临床疗效并不十分理想,有待进一步研究。     

原发性肝癌破裂出血的诊治体会

目的探讨原发性肝癌破裂出血的诊疗。方法回顾性分析1990～2005年我院26例原发肝癌破裂出血患者的诊断和治疗。结果26例均有急性上腹部疼痛和急性腹膜炎表现,影像学检查和腹腔穿刺均阳性,26例中非手术治疗11例占42.3%;5例死亡,占非手术治疗的45.5%。手术治疗15例,占67.7%;3例死亡,占手术治疗的20%。结论病史、影像学检查和腹腔穿刺在原发性肝癌破裂出血的诊断中起到重要作用,治疗根据病人的具体情况而采取保守治疗或缝扎止血、手术肝切除、肝动脉结扎等手术治疗。     

原发性肝癌并发糖代谢紊乱

目的 探讨原发性肝癌并发糖代谢紊乱的可能发生机制。方法 测定７０例原发性肝癌患者空腹血糖、空腹及餐后２小时胰岛素、Ｃ肽浓度。对检测结果进行统计分析，组间分采用ｔ检验。结果 原发性肝癌并发糖代谢紊乱４４．２９％（３１／７０），其中低血糖占２５．７１％（１８／７０），其空腹胰岛素及Ｃ肽浓度均正常，与对照组比较差异无显著性，并发高血糖占１８．６％（１３／７０），其空腹胰岛素、餐后２小时胰岛素、Ｃ肽浓度均显著升高，与对照组比较有显著性差异（ｐ〈０．０１）。结论 原发性肝癌并发低血糖可能与肝葡萄糖产生率降低及葡萄糖利用率增加有关。原发性肝癌伴高血糖可能与调节血糖激素灭活障碍及胰岛素抵抗有关。     

45例原发性肝癌手术治疗的临床分析

原发性肝癌是我国常见恶性肿瘤之一，早期无明显临床症状，多数患者是因为出现明显不适前来就诊，而此时往往已经发展为晚期，错过了最佳治疗时期。为调查肝癌手术的治疗方法、手术的入路及治疗效果，作者随访了45例原发性肝癌病例并对手术治疗进行临床分析。现报告如下。     

原发性肝癌破裂出血并发失血性休克的护理

原发性肝癌破裂出血是肝癌严重的并发症,发生率为5%-26%,约占肝癌死因的10%左右,其病死率高达33%-67%。临床以失血性休克为主要表现,     

原发性肝癌手术治疗效果及预后因素分析

目的：观察手术治疗原发性肝癌的临床疗效,并对影响手术预后的因素进行分析。方法选取来我院就诊的原发性肝癌患者52例,随机分为两组,观察组26例、对照组26例,对照组应用保守治疗进行治疗,观察组应用手术治疗进行治疗。治疗后,观察两组的治疗后患者的疼痛时间、住院时间、5年的生存率等情况,并对影响预后的因素进行分析。结果分析上述52例患者的恢复情况,观察组患者的疼痛时间等情况较对照组好转所需时间短,两组的治疗后的5年生存率相比,差异具有统计学意义(P<0.05),对于手术后,影响患者的预后因素主要有肿瘤的大小及肿瘤的数目。结论原发性肝癌手术治疗方法效果要优于保守治疗,应用手术治疗后,患者的5年生存率显著提高,应在临床推广应用。     

肝切除治疗原发性肝癌68例临床外科疗效分析

肝癌是一种常见的恶性肿瘤,以手术切除为首选方法,但术后并发症多。我院共收治68例肝癌患者进行肝切除,现将临床外科疗效报告如下。1资料与方法1.1临床资料本组病例68例,其中男38例,女30例,年龄32~73岁,平均年龄51岁。合并肝硬化60例,占全部患者的88.2%,其中轻度22例(33.4%),中     

原发性肝癌并发糖代谢紊乱

目的探讨原发性肝癌并发糖代谢紊乱的可能发生机制.方法测定 70例原发性肝癌患者空腹血糖、空腹及餐后2小时胰岛素、C肽浓度.对检测结果进行统计分析,组间分析采用t检验.结果原发性肝癌并发糖代谢紊乱44.29% (31/70),其中低血糖占25.71%(18/70),其空腹胰岛素及C肽浓度均正常,与对照组比较差异无显著性.并发高血糖占18.6%(13/70),其空腹胰岛素、餐后 2小时胰岛素、C肽浓度均显著升高,与对照组比较有显著性差异(p<0.01).结论原发性肝癌并发低血糖可能与肝葡萄糖产生率降低及葡萄糖利用率增加有关.原发性肝癌伴高血糖可能与调节血糖激素灭活障碍及胰岛素抵抗有关.     

原发性肝癌破裂出血诊治的临床分析

目的 探讨原发性肝癌破裂出血的诊断和治疗.方法 回顾性分析我院20例原发性肝癌破裂出血的临床诊断和治疗.结果 本组20例均因肝癌破裂出血后急诊住院.手术治疗18例,其中肝部分切除12例,单纯缝扎压迫止血2例,缝扎压迫加肝动脉结扎止血4例,住院死亡2例.结论 肝切除是治疗原发性肝癌破裂出血最好的方法.定期的体检能减少紧急状态的发生并提高治愈率.     

原发性肝癌合并糖尿病的介入治疗

目的研究原发性肝癌合并糖尿病的介入治疗方法。方法临床明确诊断的42例肝癌合并糖尿病患者在介入治疗前后通过口服降糖药或注射胰岛素将血糖、尿糖控制在安全范围内,并对隐性感染或感染源进行治疗,然后再行肝动脉化疗灌注栓塞术。结果42例患者介入治疗前血糖均降到9.0mmol/L以下,尿糖控制在-～ ,术后均未发生严重并发症,仅有2例出现慢性胆囊炎急性发作,经抗炎、利胆治疗后安全出院。结论原发性肝癌合并糖尿病患者在血糖、尿糖降到一定的范围内,消除潜在的感染,行肝动脉化疗灌注栓塞治疗是安全可行的。     

原发性肝癌组织MicroRNA-497表达及与患者临床特征和生存率的关系

目的:回顾性分析microRNA-497(miRNA-497)在原发性肝癌(HCC)患者癌组织中的表达及与患者临床特征和生存率的关系。方法:收集2010-01—2010-10接受手术治疗的61例HCC患者,采用荧光定量PCR检测其癌组织及癌旁组织miRNA-497的相对表达量。以癌组织miRNA-497相对表达水平的中位数为界限,将61例患者分为miRNA-497高表达组(n=21)和miRNA-497低表达组(n=40)。比较癌组织与癌旁组织miRNA-497水平差异;同时分析miRNA-497高表达组与miRNA-497低表达组临床特征和预后危险因素;比较两组平均生存率和累计生存率的差异。结果:miRNA-497在癌组织中的表达明显低于癌旁组织,差异有统计学意义(P0.05)。HCC患者癌组织miRNA-497低表达组血清AFP水平、肿瘤大小、TNM分期、血管侵犯与高表达组分布差异有统计学意义(P0.05)。多因素回归分析显示血管侵犯、TNM分期、miRNA-497表达量是影响HCC患者预后的独立危险因素。Kaplan-Meier分析表明,miRNA-497低表达组平均生存期明显低于高表达组(19.0个月vs 33.3个月),1年、3年、5年累计生存率也较miRNA-497高表达组明显降低(55.0%vs 71.4%、20.0%vs 42.9%、15.0%vs 37.5%,P0.05)。结论:miRNA-497在HCC组织中的低表达提示预后不良。     

肝癌术后复发的超声随访分析

目的探讨原发性肝癌复发灶的超声表现。方法回顾性分析33例肝癌术后患者超声随访表现及临床资料。结果21例规则随访组单个复发灶最大直径平均2.0cm,其中16例表现为低回声;12例不规则随访组复发灶最大直径平均4.8cm,其中8例为低回声结节。全组19例行彩色多普勒血流显像(CDFI)检查,团块内探及彩色血流信号15例,10例频谱多普勒测及动脉搏动型曲线,平均RI值为0.73。结论超声对肝癌术后复发的诊断可提供重要依据。     

Using Deep Learning to Predict Treatment Response in Patients with Hepatocellular Carcinoma Treated with Y90 Radiation Segmentectomy

Journal of Digital Imaging - Treatment of hepatocellular carcinoma (HCC) with Y90 radioembolization segmentectomy (Y90-RE) demonstrates a tumor dose–response threshold, where dose estimates...     

A Rare Case Report: Carcinoma Pancreas with Hepatocellular Carcinoma

Synchronous double malignancies involving different organs are relatively rare and uncommon finding. We report an interesting case of double malignancy in which a patient exhibited synchronous two separate carcinomas, pancreatic and hepatocellular carcinoma (HCC). Patient was a 64-year-old male who presented primarily with symptoms pertaining to the biliary obstruction and ultrasound of abdomen revealing pancreatic head mass. HCC was detected incidentally during the investigations for carcinoma pancreas.     

Concurrent Chemoradiotherapy Shows Long-Term Survival after Conversion from Locally Advanced to Resectable Hepatocellular Carcinoma

Purpose

For locally unresectable hepatocellular carcinoma (HCC) patients, concurrent chemoradiotherapy (CCRT) has been applied as a loco-regional treatment. After shrinkage of tumors in selected patients, surgical resection is performed. The aim of this study was to evaluate prognostic factors and long-term survivors in such patients.

Materials and Methods

From January 2000 to January 2009, 264 patients with HCC were treated with CCRT (45 Gy with fractional dose of 1.8 Gy), and intra-arterial chemotherapy was administered during radiotherapy. Eighteen of these patients (6.8%) underwent hepatic resection after showing a response to CCRT. Cases were considered resectable when tumor-free margins and sufficient remnant volumes were obtained without extrahepatic metastasis. Prior to operation, there were six patients with complete remission, 11 with partial remission, and six with stable disease according to modified Response Evaluation Criteria in Solid Tumors.

Results

In pathologic review, four patients (22.2%) showed total necrosis and seven patients (38.9%) showed 70-99% necrosis. A high level of necrosis (≥80%) was correlated with low risk for extrahepatic metastasis and long-term survival. In univariate analyses, vessel invasion and capsular infiltration were significantly correlated with disease free survival (DFS) (p=0.017 and 0.013, respectively), and vessel invasion was significantly correlated with overall survival (OS) (p=0.013). In multivariate analyses, capsule infiltration was a significant factor for DFS (p=0.016) and vessel invasion was significant for OS (p=0.015).

Conclusion

CCRT showed favorable responses and locally advanced HCC converted into resectable tumor after CCRT in selected patients. Long-term survivors showed the pathological features of near total necrosis, as well as negative capsule and vessel invasion.     

Induced Differentiation of Hepatocellular Carcinoma by Natural Products

Hepatocellular carcinoma is one of the most common malignant tumors worldwide. For the difficulty of the giving sufficient dose because of the poor liver function and the low sensitivity of hepatoma cells for the chemotherapeutic agents, chemotherapy adds little to overall survival of hepatocellular carcinoma patients. The induction of terminal differentiation in tumor cells represents a possible therapeutic strategy with less toxicity. Gekko sulfated polysaccharides, isoverbascoside, Ginsenoside-Rh2, Camptothecin, 9-nitro-camptothecin, tachyplesin, Matrine, tylophorine, 7-OH-4-CH (3)- coumarin and arsenic trioxide are known to have a differentiation-inducing capability on hepatocellular carcinoma in vitro and/or in vivo. Although the therapeutic effect of the differentiation-inducing agents may not be potent when compared with that of conventional chemotherapeutic agents, they have multiple therapeutic targets, low toxicity and less probability of drug resistance. More data are required on the molecular mechanisms of therapeutic effects, dose response and potential toxicities.     

Hepatocellular Carcinoma in the Elderly: Clinical Characteristics, Treatment, Survival Analysis in Korean Patients Older than 70 Years

The prevalence of hepatocellular carcinoma (HCC) has increased in recent years. However, HCC remains poorly characterized in elderly patients, and comprehensive data are limited. This study aimed to investigate the clinical characteristics, prognostic features and survival outcome of elderly HCC patients. We retrospectively analyzed 992 HCC patients treated at Dongsan Hospital from January 2003 to December 2007. The patients were divided into two age groups: < 70 yr (n = 813) and ≥ 70 yr (n = 179). Elderly HCC patients, compared to younger patients, had significantly higher incidence of females (31.3% vs 18.9%, P = 0.001), hepatitis C-related disease (HCV antibody positivity 26.3% vs 9.2%, P = 0.001) and comorbid condition (53.6% vs 32.1%), but lower rates of hepatitis B-related disease (HBs antigen positivity 31.3% vs 69.4%, P = 0.001). There were no significant differences in underlying liver function, stage and survival outcomes. Factors significantly influencing the prognosis of HCC were Child-Pugh grade, number of HCC, level of alpha-fetoprotein, presence of metastasis. The survival outcome of older patients with HCC was not different from that of younger patients. There were no differences between groups in independent factors influencing the prognosis of HCC. Therefore, determining the optimal management strategy for elderly HCC patients is important to improve survival and long-term outcomes.     

MRI Findings and Prediction of Time to Progression of Patients with Hepatocellular Carcinoma Treated with Drug-eluting Bead Transcatheter Arterial Chemoembolization

The purpose of this study was to investigate the utility of MRI findings after drug-eluting beads (DEB) - transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma in predicting time to progression (TTP). This study included 48 patients with 60 lesions who underwent liver MRI within 3 months after DEB-TACE. MRI was assessed for arterial enhancement pattern, late washout, arterioportal shunt, signal intensity on T2-weighted image, intratumoral septa, enhancing tissue on subtraction images, and treatment response. Cox-regression analysis was performed to identify independent factors to predict TTP. TTP was calculated using the Kaplan-Meier method with the log-rank test. Per lesion, 30 achieved complete remission, 22 had a partial response, and the remaining 8 lesions displayed stable disease on MRI. Arterial enhancement pattern, washout and enhancing tissue on subtraction images from MRI were associated with viable tumor on the last follow-up computerized tomography. Arterial enhancement, washout and enhancing tissue on subtraction images were significant predictors of TTP, but only enhancing tissue on subtraction images remained a significant predictor of TTP (P=0.018) in the multivariate analysis. TTP was longer in the group without enhancing tissue on subtraction images compared to the group with enhancing tissue (601 days vs. 287 days, P<0.001). Enhancing tissue on subtraction images from MRI after DEB-TACE is predictive for longer TTP.

Graphical Abstract

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