血清性激素水平与肝细胞癌转移关系的初步研究

应用放射免疫分析法（ＲＩＡ）对２８例原发性肝细胞癌（ＨＣＣ）患者血清雌二醇（Ｅ２）、垂体泌乳素（ＰＲＬ）、睾酮（Ｔ）水平进行了检测。结果表明，ＨＣＣ转移组血清Ｅ２、ＰＲＬ水平明显高于未转移组，Ｔ水平明显低于未转移组，结果具有显著性差异。结果提示：血清Ｅ２、ＰＲＬ、Ｔ的改变与ＨＣＣ的转移过程密切相关。     

胆管神经内分泌癌的诊断和治疗

目的 提高对胆管神经内分泌肿瘤的认识。方法 报道国内首例肝总管神经内分泌癌合并肝脏转移，结合国内已经报道的8例未发生转移病例，总结该病的诊断和治疗。结果 男性3例，女性6例，8例以梗阻性黄疸起病，2例合并类癌综合征，梗阻部位胆总管下段2例，肝总管6例，胆总管中段1例，手术前均未能确诊；采取探查性手术，5例行根治性切除胆管空肠吻合术，2例行Whipple手术，1例行姑息切除＋肝动脉插管化疗，1例外引流，手术后病理确诊。结论 胆管神经内分泌癌是一种少见的胆道恶性肿瘤，梗阻性黄疸是常见的症状，NSE、Cg-A、SYP等免疫组化染色是诊断的要点；手术切除率高，根治性切除是治疗的首选，如果肿瘤转移，姑息性切除＋肝动脉化疗是比较好的选择。     

E-cadherin的表达与肝细胞癌侵袭和转移的关系

目的研究上皮性钙黏蛋白（E-cadherin）在人肝细胞癌（HCC）中的表达情况,探讨其与肝癌的相关性。方法选择56例有完整随访资料的肝细胞癌及相应癌旁组织标本、20例正常肝组织标本,用RT-PCR方法检测E-cadherinmRNA的表达;用免疫组织化学方法检测E-cadherin的表达。结果①E-cadherin在肝细胞癌组织中的表达显著低于癌旁组织和正常组织（P〈0．05）,而在癌旁组织和正常组织中的表达无差异;②E-cadherin在肝癌组织中的表达与术后复发时间呈正相关（P〈0．05）,与病理分期呈负相关（P〈0．05）;③癌组织中E-cadherin表达与肝外转移呈负相关（P〈0．05）;④癌旁组织中E-cadherin表达与术后复发时间呈正相关（P〈0．05）。结论E-cadherin表达缺失或下调与肝癌的分化程度、侵袭转移能力和复发倾向相关,对肝癌临床转归的评估有一定指导意义。     

埃兹蛋白在肝细胞癌及其转移灶中的表达及意义

目的:了解人埃兹蛋白(ezrin)在正常肝、肝硬化组织、肝细胞癌(HCC)及其转移灶中的表达情况,并探讨其表达与肝细胞癌侵袭转移的关系。方法:用两步免疫组化染色法检测6例正常肝,25例肝细胞癌及14例转移灶中埃兹蛋白的表达;用Westernblot检测上述组织及12例肝硬化组织中埃兹蛋白的表达。结果:在正常肝、肝细胞癌及转移灶中,埃兹蛋白的强阳性表达率分别为0%、28%、57.1%,各组织中埃兹蛋白的表达差异均有统计学意义(P<0.05)。Westernblot的结果表明,转移灶中埃兹蛋白平均表达量是正常肝中的12.6倍,硬化肝中的4.7倍,肝细胞癌中的1.8倍。结论:埃兹蛋白的高表达与肝细胞癌的侵袭转移关系密切,可能是影响肝细胞癌患者预后及癌细胞转移的一个重要因素。     

卵巢转移癌的超声图像特征分析

目的：探讨卵巢转移癌的超声图像特征,以提高疾病诊断的准确性。方法选择2008年1月~2012年12月收治的51例卵巢转移癌患者纳入研究,将其作为观察组,并将同期收治的49例卵巢癌患者(A组)、65例卵巢囊腺瘤患者(B组)、50例卵巢交界性肿瘤患者(C组)作为对照组,通过超声图像分析,比较各组患者的图像特征。结果转移癌多为囊实性,边界多清晰,一般囊区≤3个,呈类圆形且内无乳头或实性回声、壁光整。卵巢癌囊性或实性,边界多不清,一般囊区>3个,囊壁不光整或呈不规则形。囊腺瘤与交界性肿瘤也属于类圆形囊区,但囊中实性成份较多。观察组的血流频谱获及率明显高于B、C两组,RI平均值明显低于B、C两组,伴腹水率明显高于B、C两组,组间差异有统计学意义(P<0.05)。结论卵巢转移癌具有特征性的超声图像表现,这是与卵巢癌、囊腺瘤、交界性肿瘤等疾病鉴别的重要指标。     

病毒性肝炎和肝细胞癌的病理诊断——进展与问题

病毒性肝炎及肝癌一直是危害人类健康的最主要肝脏疾病 ,多年来人们应用各种研究技术对这二类疾病进行了大量的研究 ,已取得了可喜的成果。尤其是近 10年来 ,由于其病因学 ,发病学等方面令人嘱目的进展 ,更进一步使得病理学家对这二类疾病的形态学表现及病理诊断有了许多新的认识。一、病理性肝炎的病理诊断虽然很多病毒都可引起肝脏的炎性病变 (如Ｅｐｓｔｅｉｎ Ｂａｒｒ病毒 ,巨细胞病毒等 ) ,但病毒性肝炎是指由所谓的嗜肝病毒引起的肝炎。目前已证实与肝脏疾病有关的嗜肝病毒包括甲型、乙型、丙型、丁型和戊型肝炎。在我国前 3种病毒性…     

肝细胞癌抗原587基因甲基化调节HCA587-TAF9互作介导肝细胞癌的侵袭和迁移

目的：研究肝细胞癌抗原587（HCA587）在肝细胞癌（HCC）组织中的表达和启动子区甲基化状态,探 讨HCA587对肝细胞癌细胞迁移和侵袭的调节机制。方法：纳入肝细胞癌肿瘤组织114 例,分为HCC组和癌旁 非癌组织（NT）组。荧光定量PCR 检测HCA587的mRNA表达量;免疫组织化学和免疫印迹检测HCC组和NT 组组织中HCA587的蛋白表达。基于甲基化敏感酶和甲基化依赖酶酶切,并结合荧光定量PCR 方法分析肝细胞 癌组织中HCA587基因启动子区甲基化状态。构建重组HCA587过表达质粒（pcDNA3.1-HCA587）,培养人肝 细胞癌细胞系BEL-7404,转染pcDNA3.1-HCA587 或者使用甲基化抑制剂5-Azacytidin 处理细胞。细胞分为对照 组、5-Azacytidin 组、pcDNA3.1-HCA587 组和pcDNA3.1-HCA587 空载体（EV） 组。免疫沉淀法分析HCA587 与TATA 盒结合蛋白相关因子9（TAF9）的结合,Transwell 小室检测细胞的迁移和侵袭能力。结果： 与癌旁非 癌组织组比,HCC组的HCA587在mRNA和蛋白水平均上调。免疫组织化学证实HCC组组织中HCA587阳性表 达。HCC组中HCA587的启动子区CpG 岛甲基化水平降低。体外实验结果显示,5-Azacytidin 促进BEL-7404 中 HCA587的表达、HCA587与TAF9的结合、BEL-7404 细胞的迁移和侵袭能力,但抑制HCA587甲基化水平;另外, HCA587过表达增强BEL-7404 细胞的迁移和侵袭能力。结论：HCA587高表达或抑制其启动子区甲基化可以促进 HCA587与TAF9的结合及导致肝细胞癌细胞的迁移和侵袭。     

人肝细胞癌单克隆抗体的免疫组化定位及鉴别诊断的初步应用

用临床手术切除的新鲜肝癌姐织作为抗原免疫动物，细胞融合，筛选出一株抗人肝癌细胞膜的单克隆抗体。此抗体采用ABC法对50例临床病理诊断为肝细胞肝癌的组织工切片作免疫组化定位诊断，结果44例为阳性，6例为阴性，阳性率为88%。但有两例阴性在电镜观察，一例见到神经分泌颗粒，确诊为胰腺肿瘤。另一例确诊鳞癌。抗体对35例肝外肿瘤的定位表明．仅对少数鳞癌和移行细胞癌有交叉反应。与全身绝大部份脏器组织元交叉反应。因此认为，此抗体对肝癌组织有一定特异性，对肝癌细胞亲合力较好，对临床活检诊断与鉴别诊断有潜在的实用价值。     

胆总管探查在胆管结石中应用的临床分析

目的 探讨开腹胆总管探查的适应条件、必要性、并发症及胆总管探查的最新进展。方法 对两家医院在2014年1月~2017年6月行开腹胆囊切除胆总管探查术62例患者的临床资料进行回顾性分析,探讨术中胆总管探查的必要性。结果 62例均痊愈,术中证实胆总管扩张 54例,胆总管探查发现结石50例,术中胆道镜探查发现残余结石14例,术后有4例患者出现并发症,其中胆总管残余结石1例,胆道感染2例,胆汁性腹膜炎1例。结论 开腹进行胆总管探查仍具有不可替代的位置,对于胆管多发结石、胆总管明显扩张的患者,术中胆道镜探查是必要的。     

生物标记物在肝细胞肝癌诊断中的应用

肝细胞肝癌( hepatocellular carcinoma, HCC)是世界上常见的一种恶性肿瘤,在中国的发病率和死亡率均很高。近年来,许多研究发现了一些新的生物标记物具有潜在的诊断和预后价值,这些生物标记物不仅可以用于HCC的早期诊断和预后判断,也有助于确定治疗干预中的潜在靶标,为HCC的临床诊断提供参考和依据。     

Ulrastructure of Liver Cell and Bile Duct Carcinomas

The primary concerns of the surgical pathologist examining a biopsy specimen are whether a particular neoplasm is originating within the liver or is metastatic and, if a primary, whether differentiation is toward liver cells or bile ducts. The present study was undertaken in the hopes of providing a broader concept of the ultrastructural spectrum of liver cell carcinoma (LCC) and a more precise understanding of the changes occurring in these neoplasms with dedifferen-tiation. The 20 liver cell carcinomas, 13 bile duct carcinomas (BDC), and 3 hepatoblastomas were studied ultrastructurally and the findings correlated with light microscopic sections stained by hematoxylin-eosin and the periodic acid-Schiff procedure with and without prior diastase digestion. Immunocytochemical staining for α₁ -antitrypsin was carried out on selected tumors. Ultrastructural study can be useful in the distinction of LCC from BDC in the minority of cases in which this is difficult by tight microscopy. While true mixed tumors appear to be uncommon, duct formation can be simulated by LCC cells. The extent to which electron microscopy will enable the pathologist to separate metastatic neoplasms in the liver from primary liver cell tumors depends on the relative ultra-structural features. Assessment of the value of electron microscopy as an aid to light microscopy in the histo-logic grading of LCC and BDC will require further study.     

肝内胆管结石的外科治疗

肝内胆管结石是我国常见病,但其病变复杂,临床治疗具有一定难度。目前肝内胆管结石的治疗原则为“解除梗阻、清除病灶、取净结石、通畅引流”,治疗肝内胆管结石最有效的方法是外科手术。现代医学的发展使肝内胆管结石的外科治疗手段多样化,微创外科治疗理念深入人心。本文主要就近年肝内胆管结石的外科治疗研究进行综述。     

高尔基体糖蛋白73与甲胎蛋白异质体百分比及总胆汁酸在原发性肝癌的表达及其临床应用

目的 探讨联合检测高尔基体糖蛋白73(GP-73)与甲胎蛋白异质体百分比(AFP-L3％)和总胆汁酸(TBA)在原发性肝癌诊断中的临床应用.方法 收集2013年5月至2013年12月期间,在我院确诊的肝癌患者100例(PHC组),肝硬化患者50例(肝硬化组)和正常对照者50例(对照组).用酶联免疫法分别检测GP-73、AFP-L3的浓度;用放射免疫法检测AFP的浓度,并计算出AFP-L3％;用循环酶法检测TBA水平,然后分别按照检测项目统计分析.各组阳性率比较采用x2检验,P＜0.05为差异有统计学意义.结果 原发性肝癌组GP-73、AFP-L3％、TBA明显高于肝硬化组和正常对照组,差异有统计学意义(P＜0.05);三项联合检测的阳性率为95.0％,明显高于单项分别测定GP-73、AFP-L3％、TBA的阳性率,差异有统计学意义(P＜0.05);GP-73、AFP-L3％、TBA的阳性率明显高于AFP的阳性率,差异有统计学意义(P＜0.05).结论 血清GP-73、AFP-L3％和TBA联合检测明显提高原发性肝癌的阳性率,对原发性肝癌的早期诊断有重要的临床意义.     

A Case of Vanishing Bile Duct Syndrome after Drug-Induced Liver Injury Caused by Pelubiprofen

Vanishing bile duct syndrome (VBDS) is a rare disease characterized by ductopenia and cholestasis, and is linked to immunological damage to the bile duct system. VBDS can be triggered by infection, ischemia, autoimmune diseases, adverse drug reactions, and humoral factors associated with malignancy. A few cases of VBDS associated with nonsteroidal anti-inflammatory drug-related drug-induced liver injury (DILI) have been reported. Here, we report a case of a 29-year-old patient who developed DILI that progressed to VBDS after the administration of pelubiprofen.     

Advances in Risk Factors for Recurrence of Common Bile Duct Stones

Choledocholithiasis is a chronic common disease. The incidence of cholelithiasis is 5%-15%, of which 5%-30% are combined with Choledocholithiasis. Although endoscopic cholangiopancreatography (ERCP) + endoscopic sphincterotomy (EST) is the most common treatment procedure, which clearance rate is up to 95%, the incidence of recurrent choledocholithiasis was 4%-25%. The risk factors of recurrence after choledocholithiasis clearance are the focuses of current researches, which are caused by multiple factors. We first systematically summarize the risk factors of common bile duct stones (CBDS) recurrence into five aspects: first-episode stone related factors, congenital factors, biological factors, behavioral intervention factors, and the numbers of stone recurrence.     

Challenge and Hope in Radiotherapy of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is one of the most critical global health issues. With frequent association of viral liver disease, HCC is highly complex, harboring both cancer and chronic liver disease. The tumor stage and underlying liver function are both major determinants of the treatment selection as well as prognosis in HCC patients, thus allowing no more than a 20% chance for potentially curative therapies. Radiotherapy technology has been evolved remarkably during the past decade, and radiation can be precisely delivered, thereby permitting higher doses to the tumour and reduced doses to surrounding normal tissues. There has been increasing interest in the merits of radiotherapy in HCC over the past few years, as indicated by a Pub Med search. Radiotherapy has been used as the definitive therapy with curative intent in early stage tumours. It has been used also in combination with TACE for intermediate stage tumours. In locally advanced tumours, radiotherapy has been combined with systemic agents. Despite its efficacy, radiotherapy has not yet been incorporated into the standard management guidelines of HCC. The lack of high evidence level data, especially randomized controlled trials, has posed an obstacle in including radiotherapy into the routine treatment schema of HCC. Therefore, well-designed prospective studies are strongly recommended using developing technology for radiotherapy alone or combination therapies. Also, many issues such as the optimal dose-fractionation, intra- or extrahepatic metastasis after radiotherapy, and radiation-induced hepatic dysfunction remain to be solved. In this review, current status of radiotherapy for HCC will be discussed with regard to technical consideration and combination strategy. The limitation and future perspectives will also be discussed.