经肝动脉灌注^131 I-HAblSF（ab’）2治疗肝癌合并门静脉癌栓疗效分析

目的探讨经肝动脉灌注^131 I-HAbl8F（ab’）2治疗肝癌合并门脉癌栓的价值。方法8例合并门脉癌栓的晚期肝癌患者行经肝动脉超选择灌注^131 I-HAbl8F（ab＇）2临床治疗性试验，剂量：0．75mCi／kg。分析症状、卡氏评分、肝功能、AFP及肿瘤CT等影像变化，随访近期疗效。结果7例疼痛患者中，3例症状缓解。3例卡氏评分增加、4例稳定。6例AFP异常患者治疗后3例下降。全组病例用药后肝功能损害均无明显加重。1例无明显症状的弥漫型肝癌患者治疗后病灶减少；余7例中，瘤体增大5例、缩小2例，其中，PR2例，临床有效率28．6％。本组1例1年随访时生存。结论经肝动脉灌注0．75mCi／kg ^131 I-HAbl8F（ab＇）2对合并门脉癌栓的肝癌患者肝功影响小，对门脉分支癌栓患者有较好的疗效。     

肝癌组织中HOXA9 mRNA的表达及其临床意义

目的研究肝癌病例癌组织、癌旁组织及非癌肝组织中HOXA9 mRNA的表达及其临床意义.方法标本经10%中性福尔马林固定后常规制作石蜡包埋切片,HOXA9 mRNA行原位杂交检测.结果临床分析发现术后血清AFP值、AFU值、Glo值、PAB值及SHCSP阳性率均有明显减少.癌组织HOXA9mRNA阳性表达评分(1.94±1.69)明显低于非癌肝组织(3.17±1.70),两者有显著差异;癌旁组织HOXA9mRNA阳性表达评分(2.54±1.20)与非癌肝组织及癌组织无显著差异.癌组织、癌旁组织及非癌肝组织三者HOXA9mRNA阳性表达率(54.84%、76.92%、83.33%)无显著差异.除HCC中HOXA9RNA阳性表达评分(1.81±1.78)显著低于MHC(2.75±0.50)外,HOXA9mRNA表达阳性率及阳性评分与癌分化程度、AFP值、SHCSP是否阳性、AFU值、肝硬化有无、转移情况、有无癌栓、大体形态及肿块最大径等临床病理特征均无明显关系.结论本研究结果显示HOXA9mRNA可能与肝癌的发生有密切关系.临床上检测HOXA9mRNA的表达情况对肝癌的早期发现和早期诊断可能有较重要的临床意义,值得深入研究.     

中国原发性肝癌临床分期预测肝癌肝移植预后的临床研究

目的评价“中国原发性肝癌临床分期”对肝癌肝移植疗效的预测价值。方法对1993年4月至2003年1月我科59例采用肝移植治疗的肝癌病人临床资料进行回顾性分析,按中国原发性肝癌临床分期原则进行分期,比较各期间肝癌肝移植疗效。结果Ⅰb、Ⅱa、Ⅱb、Ⅲa和Ⅲb期移植术后1年生存率分别为83·33%、66·67%、50·00%、35·71%和16·67%,各期间术后累计生存率有统计学差异(P<0·01);Ⅰb~Ⅱb和Ⅲa~Ⅲb期移植术后1年生存率分别为66·67%和25·00%,2年生存率分别为45·71%和25·00%,两组间术后累计生存率有统计学差异(P<0·05)。结论中国原发性肝癌临床分期适用于肝癌肝移植术前分期。     

Effect of Ligustrazine on Bone Marrow Microenvironment and Signal Transducti on Path in Irradiation Injured Mice

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影响原发性肝癌肝移植治疗的预后因素分析

目的分析影响肝癌肝移植术后生存率和无瘤生存率的危险因素,探讨国内肝移植治疗肝癌的选择标准。方法对67例接受同种异位原位肝移植治疗的原发性肝癌病人的基本资料和肿瘤相关资料包括术前病情分级、血清AFP水平、术前辅助治疗以及肝癌大小、数目、pTNM分期、肿瘤恶性程度分级等因素进行单因素和多因素分析。结果术后1年、2年累积生存率为77%、67%,6个月和12个月无瘤生存率为66%和58%。单因素分析显示对肝癌肝移植术后累积生存率影响有统计学意义的因素为CHILD分级(MELD积分)和肝外大血管侵犯;多因素分析影响肝癌肝移植术后无瘤生存率有统计学义的因素是肿瘤大小、大血管侵犯和肿瘤分化程度。结论影响肝癌肝移植术后生存率的因素仍是术前患者肝功能状态。对存在大血管侵犯的肝癌患者需严格控制肝移植术适应证,而无血管侵犯的患者在选择肝移植治疗时肿瘤大小指标可较米兰标准适当放宽。     

调脂宜从肝脾入手

中医学认为血脂异常在病机方面属“痰浊”、“血瘀”范畴，生理上与中医之膏脂相类似，属津液之范畴，肝脾功能的正常是血脂正常代谢的重要条件，脾“化”的相对不足是血脂代谢异常的根本原因；肝失疏泄是血脂代谢失常的重要因素，治疗的根本在于截断血脂失调的源头，或者扭转已有的病理趋势，使其不再发生代谢紊乱。     

Successful Liver and Kidney Transplantation From Cadaveric Donors With Left-Sided Bacterial Endocarditis

Bacterial infections are frequent in cadaveric organ donors and can be transmitted to the transplantation recipient, which could have devastating consequences for the recipients if adequate preventive measures are not adopted.
From the 355 consecutive brain dead cadaveric organ donors procured at our center in the last four years, 2000–2003, four of them (1.1%) had bacterial endocarditis as cause of death. The bacteria responsible for the endocarditis were Staphylococcus epidermidis, coagulase-negative Staphylococcus , Staphylococcus hominis and Streptococcus viridans , respectively. We performed five kidney and two liver transplantations on seven recipients. All donors and recipients received antibiotic treatment against the germ causing the respective endocarditis.
Infection by the bacteria responsible for the endocarditis in the respective donors was not transmitted to any of the recipients. Six of the seven recipients were alive with normal-functioning grafts after between 13 and 24 months' follow-up. Transplantectomy was performed on one kidney recipient due to thrombosis of the renal vein of the graft not related to the endocarditis.
Liver and kidney transplantation from donors dying from bacterial endocarditis can be performed without causing the transmission of infection to the recipient or the dysfunction of the graft.     

肿瘤干细胞与肝癌干细胞

肿瘤起源于干细胞的假说正在各种人类肿瘤中得到证实,肿瘤不单是一种基因病,而且是一种干细胞病,基因突变作用于干细胞,干细胞突变成为肿瘤干细胞,这是肿瘤发生、再生、转移和复发的关键。肝细胞癌是最常见的恶性肿瘤之一,其中是否存在“肝癌干细胞”的问题一直倍受人们关注。该文介绍肿瘤干细胞与肝癌干细胞的研究情况。     

Does Additional Doxorubicin Chemotherapy Improve Outcome in Patients with Hepatocellular Carcinoma Treated by Liver Transplantation?

The aim of this prospective randomized study was to determine whether additional doxorubicin chemotherapy improves outcome in patients with hepatocellular carcinoma (HCCA) treated by liver transplantation. Stratification parameters were tumor stage (UICC I-IVa), gender, age 50 years, α-fetoprotein 20 ng/mL, cirrhosis and HbsAg status. For pre-operative chemotherapy doxorubicin (15 mg/m²) was given biweekly, intra-operative chemotherapy was a single dose administered before surgical manipulation. Post-operative chemotherapy from day 10 was as given preoperatively for a total dosage of 300 mg/m². Outcome parameters were overall survival (OS) and disease-free survival. Of the 75 consecutive patients who received liver transplantation for treatment of HCCA, 62 patients were enrolled. Thirty-four patients were randomized in the chemotherapy group; 28 patients were in the control group and transplanted only. OS rates at 5 years were 38% in the chemotherapy group and 40% in the control group, disease-free survival rates at 5 years 43% and 53%, respectively. Tumor stage and vascular invasion were identified as independent risk factors for recurrence of disease. Doxorubicin chemotherapy did not improve organ survival and disease-free survival in patients undergoing liver transplantation for HCCA.