72例非结直肠源性肿瘤肝转移的外科治疗和预后因素分析

目的 探讨非结直肠源性肝转移的外科治疗和预后相关因素.方法 对72例行手术切除的转移性肝癌患者的临床资料进行回顾性分析.72例患者中,男性32例,女性40例;年龄35～78岁,中位55岁.原发肿瘤位于乳腺16例,肺脏14例,食管、胃及小肠12例,胆囊和胰腺8例,妇科肿瘤8例,恶性黑色素瘤4例,肉瘤4例,泌尿系肿瘤2例,其他4例.单发病灶59例,多发病灶13例;肿瘤直径1.5～11 cm不等,平均4.8 cm.异时性肝转移66例,同时性肝转移6例.结果 72例患者中,根治性切除68例(94.4％),镜下切缘阳性4例(5.6％).本组患者无围手术期死亡.住院天数6～67 d,平均14.4 d.中位生存时间31(6～127)个月;1年、3年及5年生存率分别为81.9％、37.5％及23.6％.单因素分析显示,原发肿瘤部位(乳腺和非乳腺)、肝转移灶组织学类型(腺癌和非腺癌)、术后是否应用化疗、转移灶个数(单发和多发)以及确诊原发灶与发现肝转移的间隔时间(≤12个月和＞12个月)与患者预后相关(P＜0.05).多因素分析显示非乳腺来源(P=0.012)、多发肝转移(P=0.008)、确诊原发灶与发现肝转移的间隔时间≤12个月(P=0.027)是影响肝转移癌患者预后的独立危险因素.结论 肝切除对于非结直肠源性肝转移癌是安全、有效的治疗方法.确诊原发灶与发现肝转移的时间间隔是影响患者预后的独立因素.对于单发病灶或来源于乳腺的肝转移癌应积极手术治疗.     

腹腔镜结直肠癌切除术联合射频消融治疗肝转移癌

目的 探讨腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌的临床价值.方法 2001年12月至2006年7月成都市第三人民医院对22例结直肠癌合并同时性肝转移的患者施行腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌,术后通过增强CT检查评价消融灶固化效果.采用X2检验分析疗效.结果 本组22例患者中8例肝转移癌为多发,16例有合并症.对31个肝转移癌进行RFA治疗,未发生相关并发症;术后平均住院时间为(14±5)d,无手术死亡.5例因消融不完全进行重复RFA,4例消融灶复发(2例重复RFA);6例死亡(2例死于消融灶复发).消融灶复发率为18%(4/22),病死率为27%(6/22).肝转移癌直径≥2.0 cm者RFA后消融灶复发率高于直径＜2.0 cm者(x2=5.867,P＜0.05).结论 腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌,为多发性肝转移癌、合并基础疾病、高龄、手术耐受差和肿瘤切除困难的结直肠癌患者提供了治疗的机会.     

阑尾类癌的外科治疗

目的探讨阑尾类癌的外科治疗方法。方法对经手术治疗的27例阑尾类癌患者的病例资料进行回顾性分析。结果27例患者术前均误诊，但术后均经病理确诊阑尾类癌。18例肿瘤直径小于1cm者及2例肿瘤直径1～2cm且肿瘤局限于浆膜内、不伴淋巴结转移者．采用单纯阑尾切除术，均生存5年以上；4例肿瘤直径1～2cm且位于基底部伴淋巴结转移。采用回盲部切除，其中3例存活超过5年，1例术后28个月死于肝转移；3例肿瘤直径大于2cm，且位于基底部伴淋巴结转移者，其中2例采用右半结肠切除，辅以术后化疗，1例存活，1例5年内死于肝转移；1例伴肝转移．采用姑息性回盲部切除加肝转移灶酒精注射．3年内死亡。结论阑尾类癌应根据肿瘤大小、部位、浸润深度及有无转移确定切除范围。     

结肠直肠癌肝转移灶冷冻治疗的远期效果

荷兰 Nijmegen大学医疗中心于 1994～ 1999年曾为 30例结肠直肠癌肝转移灶行冷冻治疗 ,采用LCS2 0 0 0型冷冻机器 ,探头 5、10 cm,冷冻时间一般为2 0分钟 ,解冻至少 10分钟 ,进行长期随访。16例为同时性肝转移 ,14例为异时性肝转移。 11例原用化疗治疗转移灶达 10 .5个月 ,其中 8例的转移灶继续增大 ,另有 8例在化疗过程中出现肝转移灶。治疗方法和肿瘤大小如附表所示 :附表　治疗方法和肿瘤大小转移灶数目 转移灶大小(最大径 )冷冻治疗的转移灶大小<4≥ 4 <4 cm≥ 4 cm<4 cm ≥ 4 cm病例数 16 14 92 1仅用冷冻治疗 4 316加用手术切除 12 …     

结直肠癌肝转移治疗体会

目的探讨结直肠癌肝转移的外科治疗。方法对新郑市人民医院1996年1月至2005年12月间手术治疗的12例结直肠癌肝转移病例资料,进行临床和病理资料的回顾性分析。结果12例患者同时癌4例,异时癌8例。肝转移灶根治性切除4例(33.3%),即手术切缘距离肿瘤边缘超过1.0 cm,肝转移灶均被切除;姑息性切除组8例(66.7%),即手术切缘有癌组织残留或肝门静脉、胆管内有癌栓或肝门部有转移淋巴结。本组患者生存期为4~76个月,中位生存期为35.1个月,5年生存期为25.0%。结论根治性切除是结直肠癌肝转移患者的重要手段。     

结直肠癌肝转移一期联合手术化疗的临床研究

目的探讨结直肠癌肝转移一期联合手术辅助化疗的有效途径及临床价值.方法回顾性分析一期联合手术切除原发癌及转移癌,经肝动脉门静脉双置泵栓塞灌注化疗,肿瘤局部注射无水酒精及热电疗法综合性治疗结直肠癌肝转移36例的临床资料.结果本组36例结直肠癌患者原发癌均获切除,其中一期切除肝转移癌17例,6例复发,4例再次手术切除.19例不能切除的转移性肝癌,行肝动脉门静脉双置泵栓塞灌注化疗,无水酒精注射和热电疗法.肿瘤直径平均缩小57%,其中4例因肿瘤缩小行二期手术切除.1、2、3年生存率分别为切除组94%,82%,65%;明显高于置泵组的74%,53%,32%(P<0.01).结论结直肠癌肝转移一期联合手术切除加肝动脉门静脉双置泵栓塞灌注化疗,是一种首选而有效的治疗方法.不能切除肝转移癌者,只要切除原发肿瘤,肝动脉门静脉置泵栓塞灌注化疗,可明显延长病人生存期,改善预后.     

肝门区大肝癌的手术切除（附23例报告）

肝门区大肝癌手术切除风险性大 ,既往被视为手术禁区。作者 1996年～ 2 0 0 2年共收治肝门区大肝癌 2 3例 ,报告如下。临床资料1.本组共 2 3例 ,男 16例 ,女 7例 ;年龄 36～ 6 2岁 ,中位年龄 4 8.3岁 ;病程 1～ 9个月。其中 ,原发性肝癌 18例 ,转移性 5例。肿瘤部位 :尾状叶 1例 ,4段 5例 ,4～ 5段 4例 ,5段 3例 ,7段 5例 ,8段 5例。AFP阳性 14例。肿瘤直径 5 .1～ 15cm。其中 ,合并肝硬化 19例 ,门静脉癌栓 7例 (主干 2例 ) ,胆管癌栓 1例。一期手术切除 18例 ,介入栓塞缩小后 (TACE)切除 5例。2 .手术方式 :右三叶切除 1例 ,肝中叶切除…     

大肠癌并肝转移癌的外科治疗（附21例分析）

目的探讨大肠癌并肝转移癌的外科手术治疗的效果。方法对我科1994～2004年共21例大肠癌并肝转移癌行外科手术治疗患者的资料进行分析。结果对16例同时性转移癌中12例行原发灶加肝转移灶同期切除。4例行分期切除。异时性转移癌5例行切除；其中肝转移癌局灶切除4例，左外叶切除7例，左半肝切除3例，右半肝切除2例；右肝前、后叶切除共5例。1、3、5年的生存率分别为90．5％、52．4％、28．6％。结论对大肠癌并肝转移癌，行原发病灶加肝转移灶切除是提高生存率的关键。     

腹腔镜辅助下原发性肝癌和肝转移癌的射频消融术治疗

目的 :探讨腹腔镜辅助下肝癌射频消融术治疗的优势。方法 :全麻下联合腹腔镜技术对原发性肝癌和多发的肝转移癌灶行射频消融术治疗。结果 :1 0例患者 32个瘤体 ,其中直径 5cm的 2 0个瘤体均一次手术热凝损毁 ,CT和MRI提示肿瘤坏死 ,其中 ,1 5个瘤体完全缓解 (CR)占 75 % ,5个瘤体部分缓解 (PR)占2 5 % ,近期疗效CR +PR为 1 0 0 %。随访 2～ 1 4个月无复发。直径 >5cm的 1 2个瘤体亦予以一次性热凝损毁 ,术后 1～ 8周内AFP、CEA、CA1 9 9肿瘤指标均转阴或下降 ,CT或MRI提示肿瘤热凝损毁 ,近期疗效CR +PR为 83 3%。患者均能耐受射频消融治疗 ,无并发症发生。 1例原发性肝癌术后 1 3个月死于肿瘤扩散。结论 :腹腔镜辅助下肝癌射频消融术治疗直径 5cm的瘤体效果显著 ,对直径 >5cm的瘤体部分有效。此法为腹腔镜辅助下结直肠癌手术中多发肝转移癌灶的处理提供了一种创伤小、时间短、见效快、安全方便的治疗方法。     

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目的　探讨经皮射频消融联合肝动脉、门静脉栓塞化疗在不能手术切除的肝癌治疗中的价值。方法　从 2 0 0 0年 9月至 2 0 0 3年 3月 ,佛山市第一人民医院对符合条件的 2 0例原发性和转移性肝癌病人先行肝动脉栓塞化疗 (TACE)和门静脉栓塞化疗 (PVCE) ,再在B超引导下经皮射频消融 (PRFA)治疗 ;另 2 0例肝癌病人直接给予PRFA治疗。治疗后定期复查B超、CT或MRI。确定肿瘤是否坏死或缩小 ,有无复发转移灶 ,肿瘤特异指标的变化。Kaplan Meier法计算无瘤生存率和累积生存率。结果　对于转移性肝癌 ,联合治疗组CEA阳性者治疗转阴率 5 0 % (2 / 4 ) ,单纯治疗组CEA阳性者治疗后转阴率 2 5 % (1/ 4 ) ,差异有显著意义。对于原发性肝癌或复发肝癌 ,联合治疗组AFP阳性者治疗后转阴率 6 2 5 % (5 / 8) ,单纯治疗组AFP阳性者治疗后转阴率30 % (3/ 10 ) ,差异有显著意义。肿瘤完全凝固坏死率 :单纯治疗组对于 <3cm瘤灶为 10 0 % (17/ 17) ,3～ 5cm为5 5 % (5 / 9) ,>5cm为 2 0 % (1/ 5 ) ;而联合治疗组 <3cm瘤灶为 10 0 % (19/ 19) ,3～ 5cm为 75 % (3/ 4 ) ,>5cm为4 0 % (2 / 5 )。肿瘤缩小率为 70 % (14 / 2 0 ) ,门静脉癌栓消失率为 2 5 % (1/ 4 ) ,缩小率为 5 0 % (2 / 4 )。肝内复发转移时间明显延长。联合治疗组     

肝切除治疗胃肠道癌肝转移14例报告

1976～1990年间外科治疗肝转移癌14例,原发灶为胃癌9例,大肠癌5例。肝转移灶呈单个结节9例,局限于半肝的多个结节3例,两侧肝各有一结节1例,一侧肝有多个结节而另一侧肝有单个结节1例。14例均行肝转移灶和原发灶同步切除。无手术死亡例。术后1年、3年和5年生存率分别为92.9％、35.7％和16.7％。文中对手术适应证及手术方法的选择进行了讨论。     

LAK cell adoptive immunotherapy and its problems

Clinical efficacy of lymphokine-activated killer (LAK) cell adoptive immunotherapy (AIT) in combination with plasma exchange and interleukin (IL-2) was investigated in 24 patients with advanced cancer. Partial response (PR) was found in 4 patients (20%), including 1 primary liver tumor, 1 metastatic lung tumor from renal cancer and 2 malignant pleural effusions from gastric and lung cancer. Based on these results new AIT in combination with plasma exchange, OK-432, IL-2 and cyclophosphamide was designed to target liver and lung tumors, in which LAK cells and other drugs were administered through the catheter located in the feeding artery of the tumor. Out of ten patients treated, 1 (10%) with metastatic liver tumor from gallbladder cancer was evaluated as PR. It is suggested that a strategy to enhance tumor accumulation and recognition of LAK cells should be attempted for development of gastrointestinal cancer therapy with AIT.     

The Influence of Total Gastrectomy on Survival in Malignant Zollinger-Ellison Tumors

The effect of total gastrectomy on the biologic behavior of malignant gastrinomas was studied from patient data collected in the ZE tumor registry. A total of 267 patients with documented metastatic tumor had definitive gastric operations. In the 137 patients who had total gastrectomy, survival was 75% at one year, 55% at five years and 42% at ten years. In the 130 patients who had lesser gastric operations, survival was 51% at one year, 27% at five years and 18% at ten years. Deaths from progressive tumor growth occurred in 17% of the patients at risk after total gastrectomy and 30% of the patients at risk after lesser gastric operations. A subgroup of 127 patients with documented liver metastasis had definitive gastric operations. Seventythree patients with liver metastasis had total gastrectomy with survival of 68% at one year, 42% at five years and 30% at ten years. Fifty-four patients with liver metastasis had lesser gastric operations with survival of 44% at one year, 7% at five years and none at ten years. Deaths from progressive tumor growth occurred in 25% of the patients at risk after total gastrectomy and 50% of the patients at risk after lesser gastric operations. Regression of metastatic ZE tumor was clearly documented in only four patients; all had total gastrectomy. Presumptive regression of primary tumor occurred in seven patients, five had total gastrectomy. The study clearly demonstrated that total gastrectomy was the procedure of choice for malignant ZE tumors, even in the presence of widespread metastasis. The results provided indirect evidence to support a gastric feedback effect which influences growth of gastrinomas; however, the results also show that total gastrectomy furnished neither predictable nor permanent protection from subsequent tumor growth and metastasis.     

Intra-arterial cancer chemotherapy with combined anticancer agents

Thirty seven patients with malignant tumors of stomach, liver and limb have been treated pre- and postoperatively with intra-arterial regional infusion of combined antitumor agents including cytosine arabinoside, methotrexate and mitomycin C with supplemental use of 5-fluorouracil, vincristine, vinblastine and cyclophosphamide. Six out of 11 patients with an inoperable gastric cancer showed a favorable response. In an inoperable primary and metastatic liver cancer, seven out of 9 patients, showed marked improvements such as tumor regression, restoration of liver functions and decrease of jaundice. The mean survival time was 4.5 months and one patient is still alive after 25 months. In 17 cases with the preoperative infusion, histological examinations of the tumors showed the marked degeneration of cells—the finding which seems to be superior to those otherwise obtained by single agent. The preoperative infusion of³H-thymidine followed by autoradiography of removed specimens did not show the uniform labeling of tumor cells. The radioactive labeling occurred throughout the tumor in most cases of gastric cancer and limb tumor. A major complication was leukopenia, which was observed in 13 out of 37 patients studied. This investigation was supported in part by a grant in aid for Scientific Research from the Ministry of Welfare, Japanese Government.     

脾转移性肿瘤56例临床病理分析

目的探讨脾转移性肿瘤的临床病理学特征。方法回顾性分析2012年1月~2020年12月中山大学孙逸仙纪念医院的56例脾转移性肿瘤患者的临床资料及病理学特征,并复习相关文献。排除累及脾的淋巴造血系统肿瘤。结果脾肿瘤139例,占同时期我院脾手术病例的11.82%。脾淋巴造血系统肿瘤44例,非淋巴造血系统肿瘤95例,其中转移性肿瘤56例。脾转移性肿瘤占同时期我院脾手术病例的4.76%,占同时期我院脾肿瘤性病变的40.29%。56例脾转移性肿瘤患者中,男性26例,女性30例。发病年龄30~76岁,平均年龄53岁。56例脾转移性肿瘤包括胰腺肿瘤(19例)、卵巢癌(13例)、胃肿瘤(9例)、肝癌(6例)、肠腺癌(4例)、阑尾粘液腺癌(2例)、子宫绒毛膜癌(1例)、乳腺浸润性导管癌(1例)、肺癌(1例)。脾转移性肿瘤病理学形态与原发肿瘤相似,免疫组化染色进一步明确诊断。结论脾转移性肿瘤原发灶来源广泛,最常见的原发肿瘤是卵巢高级别浆液性腺癌和胰腺导管腺癌。通过临床⁃影像⁃病理三结合有助于正确诊断。     

肝、胃多原发癌的手术治疗分析:附14例报告

目的 总结分析肝、胃多原发癌的手术切除的治疗效果.方法 回顾性分析上海市东方肝胆外科医院自2004年1月至2008年1月收治的14例肝、胃多原发癌病人的手术切除资料.结果 14例病人中,12例病人一次手术同时切除肝脏及胃肿瘤,1例病人在肝脏肿瘤切除两个月后再行胃肿瘤手术治疗,另1例为胃窦腺癌术后两年发现肝脏肿瘤而行手术切除.中位生存期为23个月.术后1年、3年生存率分别为78.6%、35.7%.结论 肝、胃多原发癌由于病理特性不同,其治疗与转移癌、复发癌截然不同,两脏器肿瘤可行根治性切除,疗效与单发癌相似,采取积极的治疗是病人获得长期生存的关键.     

Clinicopathological features and treatment outcomes of metastatic tumors in the stomach

The metastasis of tumors to the stomach is rare, which underlies the clinical problems regarding their diagnosis and treatment. The present review summarizes the current knowledge regarding the clinicopathological characteristics, therapeutic strategies and outcomes for metastatic tumors in the stomach. The primary malignancies of the metastatic tumors in the stomach were most often breast cancers (27.9 %), followed by lung cancer (23.8 %), esophageal cancer (19.1 %), renal cell carcinoma (RCC; 7.6 %) and malignant melanoma (7.0 %). In cases of breast cancer and RCC as the primary malignancy, the median interval between the treatment of the primary tumor and diagnosis of the metastatic tumor in the stomach (IPM) was 50–78 and 75.6 months, respectively, highlighting the fact that the metastatic spread to the stomach may occur many years after the initial treatment of the cancer. In nine patients with metastatic gastric tumors arising from ovarian cancer, an endoscopic examination revealed submucosal tumors in six patients (66.7 %), with a median IPM of 30 months. Appropriate systemic treatment for these tumors is the preferred therapeutic strategy. Although solitary metachronous gastric metastasis several years after treatment of the primary tumor is an exceptionally rare event, surgical resection of metastatic gastric tumors may be recommended to control hemorrhaging or for selected tumors.     

Long-term survival after surgical resection of liver metastasis from lung cancer

Lung cancer metastasis to the liver indicates a poor prognosis, and the majority of patients with metastatic disease to the liver are not indicated for surgery because of the number or distribution of metastases or the presence of extrahepatic disease. We herein describe a case of long-term survival after a surgical resection of liver metastases from lung cancer. Six months after surgery for Stage IB primary lung adenocarcinoma, a 71-year-old male was found to have a metastatic tumor in his liver. A hepatic resection for the metastatic tumor and another small metastatic foci found intraoperatively was carried out, and the tumors were pathologically diagnosed as liver metastases from lung cancer. The patient is presently alive and well without recurrence, as of 5 years and 2 months after the liver resection. This is the first report of the successful surgical treatment of liver metastasis from lung cancer.     

Intrahepatic micrometastases around liver metastases from gastric cancer

Background/Purpose  We aimed to clarify the association between the presence of micrometastases around liver metastases from gastric cancer and the results of hepatic resection. In addition, we investigated the influence of E-cadherin and matrix metalloproteinase (MMP)-7 expression on the development of micrometastases. Methods  Micrometastases around liver metastases were examined microscopically in 31 metastatic liver tumor specimens resected from 17 patients who had undergone hepatic resection for liver metastases from gastric cancer. E-cadherin and MMP-7 expression in the primary gastric tumor, the liver metastases, and the micrometastases were examined immunohistochemically. Results  Hepatic micrometastases were present in around 48% of the liver metastases, accounting for 59% of the patients. The tumor recurrence rate in the remnant liver after hepatic resection was significantly higher, and survival significantly poorer, in patients with such micrometastases than in those without. Micrometastases tended to appear around the liver metastases that had reduced E-cadherin expression. Most of the micrometastases in the lymph ducts and sinusoids showed reduced E-cadherin expression. MMP-7 expression was not correlated with the presence of micrometastases. Conclusions  About half of the hepatic metastases from gastric cancer had seeded off micrometastases, and the presence of these micrometastases was associated with a poorer result of hepatic resection. Reduced E-cadherin expression in metastatic liver tumors may be associated with the development of micrometastases.     

A huge metastatic liver tumor from leiomyosarcoma of the inferior vena cava: report of a case

Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumor, and only a few cases of the resection of IVC leiomyosarcomas with synchronous liver metastases have been reported. This report describes a female patient who initially presented with a solitary, huge liver tumor and a retroperitoneal tumor. Following our preoperative diagnosis of primary liver cancer with a retroperitoneal lymph node metastasis, the patient underwent combined resection of both tumors. The surgical findings revealed that the retroperitoneal tumor originated from the IVC wall. The pathological and immunohistochemical findings revealed that both tumors were leiomyosarcomas. Although the liver tumor was much larger than the IVC tumor, we considered that the metastatic liver tumor arose from the IVC leiomyosarcoma. This was an instructive case because the metastatic liver tumor from the IVC leiomyosarcoma was so large as to be mistaken for a primary liver tumor.