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目的:探讨胰腺腺泡细胞癌临床特征及其诊治与预后。方法:回顾性分析中日友好医院普通外科1997年1月—2017年1月收治的14例胰腺腺泡细胞癌患者的临床资料。结果:14例患者中,男10例,女4例;平均年龄(51.6±15.6岁);初发症状为腹痛7例,黄疸3例,恶心呕吐1例,腹部包块1例,无症状体检发现者2例。患者肿瘤平均直径(9.4±5.2)cm;肿瘤位于胰体尾部10例(64%),胰头部3例,钩突部1例。术前穿刺病理或术中冷冻病理均未能准确诊断胰腺腺泡细胞癌。9例获R0切除,5例因肝转移或局部侵犯周围脏器仅行行胰腺活检或姑息切除及术后化疗。所有患者均经术后病理证实为胰腺腺泡细胞癌。免疫组化显示α-抗胰蛋白酶、α-抗糜蛋白酶、细胞角蛋白(AEl/AE3)阳性率100%。获得R0切除的9利患者,平均生存时间(32.0±25.6)个月;而未获得R0切除的5名患者平均生存时间仅为(4.0±0.8)个月。结论:对于可行R0切除的胰腺腺泡细胞癌,即使伴有肝转移,也应采取积极的手术治疗,术后辅助化疗对预后极其重要。 相似文献
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Objective To investigate the clinical features,imaging and pathologic findings of fibrolamellar hepatocellular carcinoma (FL-HCC).Methods Clinical data from 2 patients with FL-HCC confirmed by operation were analyzed retrospectively.Results There were 1 man and 1 woman,both of them were younger than 40 years.The man had hepatitis B,the woman did not have underlying hepatitis.The 2 patients had a normal hepatic function and α-fetoprotein level.Under dynamic contrast material-enhanced computed tomography,hepatic arterial phase CT images demonstrated heterogeneous enhancement of the tumor.Calcification was depicted in the CT images of 1 patients.Both of them underwent a successful operation.After 8 months of follow-up,1 patient had recurrence.And the other patient had no evidence of recurrence during 16 months follow-up time.Conclusion FL-HCC is a rare liver tumor that has distinct clinicopathologic features comparing with hepatocellular carcinoma.Most of FL-HCC occurs in young patients with normal level of α-fetoprotein and no history of hepatitis.Tumors may have calcification and become predominantly on hepatic arterial phase CT images.The most effective treatment for FL-HCC is surgical resection and prognosis is good. 相似文献
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目的 探讨肝细胞腺瘤(hepatocellular adenoma,HCA)及肝腺瘤病(liver adenomatosis,LA)的临床表现、治疗方法和预后.方法 回顾性分析经手术治疗的10例HCA及1例LA患者的临床资料.结果 本组女性发病居多,共7例(63.6%),1例女性肝腺瘤病患者有口服避孕药病史.全组中位发病年龄33(范围25~70)岁.多数无临床症状(72.7%).肿瘤标记物CA19-9和甲胎蛋白(AFP)正常.超声造影、CT及磁共振(MRI)增强扫描多提示病灶动脉期强化,门脉期、延迟期去强化.组织病理提示10例为单发病灶,诊断HCA,其中1例肿瘤细胞轻度异型及不典型增生,1例存在细胞不典型增生,1例细胞生长活跃;另外1例为多发病灶,细胞存在异型,诊断肝腺瘤病.11例患者均经手术切除,经随访21~125个月,无复发.结论 HCA患者多无明显临床表现,肝脂肪变性可能为HCA和LA的共同病因,口服避孕药物可能为LA的病因.动态影像学检查有助于诊断,HCA有病灶破裂出血及癌变危险,首选手术治疗,预后良好. 相似文献
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目的探讨新辅助化疗对结直肠癌肝脏转移瘤肝切除术后的影响。方法结直肠癌肝脏转移瘤患者57例,分为术前行新辅助化疗组(A组)23例和直接手术组(B组)34例,对比分析其疗效。结果两组均无手术30 d内死亡病例。其中输血人数、住院天数、胆漏在A组明显高于B组,差异均有统计学意义(均P〈0.05)。呼吸系统并发症、循环系统并发症,两组差异均无统计学意义(均P〉0.05)。1、3、5年生存率A组分别为:83.3%,60.2%,37.5%,而B组分别为84.8%,68.2%,32.5%,两组差异均无统计学意义(均P〉0.05)。结论术前评估肝脏转移瘤可切除的患者,如无明显手术禁忌症可直接手术治疗,这样可减少相应的术后并发症。 相似文献
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目的 探讨人外周血清循环免疫复合物(CIC)的含量变化与肝癌发生的关系.方法 采用酶联免疫吸附(ELISA)法检测20例临床病理确诊的肝癌和13例肝血管瘤患者术前血清中CIC的含量.采用ELISA法检测45例慢性乙肝病毒(HBV)感染最终进展为肝癌者以及与之匹配的45例慢性HBV感染未进展为肝癌者入组时、随访过程中和随访结束时血清中CIC和抗肝肾微粒体抗体(抗LKM-1)的含量,采用荧光定量PCR法检测这些患者入组时、随访过程中和随访结束时血清HBV-DNA的含量.结果 20例临床手术后病理确诊的肝癌患者术前血清中CIC的含量为(5738±1485)mU/L,显著高于13例肝血管瘤患者[(2410±1080) mU/L;P<0.001].45例经过长期随访最终进展为肝癌的慢性HBV感染者血清CIC的含量随病程进展而逐渐升高,在肝癌临床诊断时达到最高,与其入组时相比,差异有统计学意义(P<0.001);而对照组患者血清CIC的含量未见明显变化(P=0.118).随访方过程中,血清CIC的升高与肝癌累积发病率密切相关(HR =2.77,95% CI为1.47~5.22).最终进展为肝癌的慢性HBV感染者在入组时、随访进程中和临床确诊为肝癌时的血清抗LKM-1和HBV-DNA含量均显著高于与之相匹配的对照组,并维持在较高水平.最终进展为肝癌的慢性HBV感染者血清CIC的含量与HBV-DNA的含量之间仅在肝癌临床诊断时存在相关性(r=0.344,P=0.026).结论 在慢性HBV感染进程中,血清CIC含量的逐渐升高可能是由慢性HBV感染进展为肝癌的重要转归指标之一. 相似文献
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Objective To investigate the clinical features,imaging and pathologic findings of fibrolamellar hepatocellular carcinoma (FL-HCC).Methods Clinical data from 2 patients with FL-HCC confirmed by operation were analyzed retrospectively.Results There were 1 man and 1 woman,both of them were younger than 40 years.The man had hepatitis B,the woman did not have underlying hepatitis.The 2 patients had a normal hepatic function and α-fetoprotein level.Under dynamic contrast material-enhanced computed tomography,hepatic arterial phase CT images demonstrated heterogeneous enhancement of the tumor.Calcification was depicted in the CT images of 1 patients.Both of them underwent a successful operation.After 8 months of follow-up,1 patient had recurrence.And the other patient had no evidence of recurrence during 16 months follow-up time.Conclusion FL-HCC is a rare liver tumor that has distinct clinicopathologic features comparing with hepatocellular carcinoma.Most of FL-HCC occurs in young patients with normal level of α-fetoprotein and no history of hepatitis.Tumors may have calcification and become predominantly on hepatic arterial phase CT images.The most effective treatment for FL-HCC is surgical resection and prognosis is good. 相似文献
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