微波高功率条件下消融原发性肝癌的初步研究

目的 探讨2 450 MHz水冷微波在高输出功率下热疗肝癌的安全性、近期疗效及术后肿瘤短期复发的危险因素.方法 对93例未行其他治疗的原发性肝癌患者106个肿瘤首次行微波高功率(100 W)消融,肿瘤直径为1.0 ～ 5.85 cm.观察手术前后肝功能变化、临床症状及随访指标评价疗效,并用单因素分析肝癌复发的相关因素....     

晚期肝细胞癌肝移植术后的远期疗效和匹兹堡分级的预测价值

目的 观察晚期原发性肝癌肝移植术后的远期疗效,探讨匹兹堡分级的预测价值。方法 46例不符合米兰标准的晚期肝癌患者接受原位肝移植术,观察其术后的远期疗效。依据匹兹堡标准分为4组（Ⅰ组：1～2级,6例;Ⅱ组：3级,13例;Ⅲ组：4级,17例;Ⅳ组：5级,10例）,分别监测各组的远期生存情况,并进行组间比较。结果 46例患者的3年生存率为46．7％,3年的无瘤生存率为38．8％,平均生存期32．5个月,平均无瘤生存期27．7个月。Ⅰ组患者术后无死亡和肿瘤复发,Ⅳ组患者1年无瘤生存率仅12．5％,Ⅱ、Ⅲ组患者的3年无瘤生存率在40％左右,两组之间无明显差异。Ⅱ、Ⅲ组患者的最长无瘤随访时间为58个月。结论 晚期肝癌行肝脏移植术仍有相当的远期疗效。匹兹堡标准对1、2级和5级患者有较好的预测价值,尤其对较早期肝癌的鉴别优于米兰标准,但在3、4级患者的应用有一定的局限性。     

肝动脉化疗栓塞对肝细胞癌切除术后预防复发的研究

目的探讨预防性TACE对原发性肝细胞癌(HCC)根治性切除术后复发的影响。方法回顾性分析2008年5月—2012年3月行根治性切除并经病理学确诊的557例HCC患者,根据术后2个月内是否行预防性TACE分为两组:预防性介入组(n=327)和未施预防性介入组(n=230),分析两组间的一般临床病理资料的差异,利用Kaplan-Meier计算复发时间,log-rank检验评估不同组别患者的复发差异,采用Cox比例风险模型分析HCC术后复发的独立危险因素,并对相关独立危险因素按是否接受预防性介入进行分层分析。结果两组患者在一般临床病理资料比较差异无统计学意义。经Cox比例风险模型多因素分析发现,年龄(≤50岁)、血清甲胎蛋白(AFP,>20 ng/ml)水平、肿瘤直径(>5 cm)、手术切缘(<1 cm)、微血管癌栓(MVI)以及术后行预防性TACE是影响HCC术后复发的独立危险因素。进一步分层分析,上述5个因素的患者中,预防性TACE组的复发率较未预防性TACE组低且差异有统计学意义。结论 HCC根治性切除术后,预防性TACE可降低肝癌的总体复发率;对于肝癌确诊年龄小、术前AFP阳性、肿瘤直径>5 cm、手术切缘<1 cm和有MVI的HCC患者,预防性TACE可显著降低术后的复发率。     

原发性肝癌患者长期生存的影响因素分析

目的 对明确诊断为原发性肝癌并存活5年以上的患者,探讨影响其长期生存的相关因素及介入治疗对患者长期生存的作用.方法 对2001年1月至2010年1月以来就诊生存时间长于5年的原发性肝癌患者相关资料及治疗经过进行分析,探讨其长期生存的相关因素.结果 随访的452例原发性肝癌患者中43例存活5年以上.其中年龄、肝硬化的程度、肝内肿瘤的大小、肝内肿瘤的数量、门静脉有无受侵对患者的长期生存具有统计学意义(P＜0.01).结论 原发性肝癌患者的年龄、肝硬化的程度、肿瘤的数量、门静脉有无受侵、术后复发选择的治疗方式对患者的长期生存起着显著作用.     

CT导引下125I粒子植入治疗外照射后复发的恶性肿瘤

目的 评价外照射后复发的恶性肿瘤行CT导引下瘤体内^125I粒子植入治疗的可行性、安全性及疗效。资料与方法 2001年12月至2004年12月,14例外照射后局部复发的恶性肿瘤行CT导引下瘤体内^125I粒子植入,其中原发肿瘤8例,转移瘤6例（11个病灶）,病灶的平均直径为3．25cm。依据粒子植入术前CT图像应用计算机治疗计划系统制定粒子植入计划,按治疗计划在CT导引下穿刺植入^125I粒子。植入^125I粒子数为9．48粒（中位数为28粒）。植入术后立即CT扫描及术后2～6个月CT扫描观察粒子在瘤体内的分布、有无并发症发生及疗效。结果 14例粒子植入均顺利完成,瘤体内粒子分布满意,其中1例植入术后有2粒粒子脱落到体外,未见急性并发症和治疗相关的放射损伤。4例疼痛患者粒子植入术后疼痛均有明显减轻。14例19个病灶粒子植入后完全缓解（CR）5个,部分缓解（PR）9个,无变化（NC）4个,进展（PD）1个,近期总有效率73．7％。结论 对于外照射后复发的恶性肿瘤CT导引下瘤体内^125I粒子植入近距离放射治疗是一种安全、可行的治疗方法,近期肿瘤局部控制率满意,远期疗效有待大组病例进一步观察。     

多期CT增强扫描对术后肝细胞癌的复发风险评估

目的探究并验证多期CT检查对肝细胞癌(HCC)根治切除术后肿瘤复发的风险。方法纳入2017年3月～2018年10月在我院接受术前CT评估的128例可手术HCC患者的数据。随访数据来自医院病历。截止2019年4月的随访数据用于回顾性分析术前多相CT对可能影响肝癌患者微血管侵犯及根治性切除术后复发的术前临床资料及CT增强影像特征行单因素及多因素分析。结果在随访期间,128例患者中38例(29.7%)术后HCC复发。微血管浸润(MVI)与HCC复发相关(P0.01)。尽管术后进行了抗病毒治疗和化学药物治疗,但在44例MVI患者中,有22例在手术切除后复发。MVI的存在可以预测术后复发,敏感性为57.9%,特异性为75.6%,准确率为70.3%。在84例无MVI的肿瘤中,单因素分析证实多期相CT的肿瘤切缘等级、肿瘤包膜完整性与HCC复发相关(P0.05)。单因素分析显示,各组之间在肝包膜浸润、最大肿瘤直径、肿瘤坏死、动脉期增强率、门静脉期增强率、肿瘤周边增强无明显差异(P0.05)。结论肿瘤边缘不光滑,肿瘤包膜不完整和肿瘤包膜缺失与术后HCC复发相关。根治性切除术后HCC复发可通过CT预测。     

ⅣA期胸腺瘤的外科治疗——附7例报告

目的 探讨外科手术治疗ⅣA期胸腺瘤的安全性及远期疗效.方法 回顾性收集并分析北京大学第一医院胸外科2007年1月-2014年12月收治的7例ⅣA期胸腺瘤患者的临床资料.结果 7例ⅣA期胸腺瘤患者中男4例,女3例,中位年龄38(27～57)岁,左侧病变4例,右侧病变3例.5例为初治病例,2例为术后复发患者.手术时间为10.4±2.8h,中位出血量1000(300～8200)ml,术后中位住院时间14(10～54)d.无围术期死亡,3例(42.9％)术后出现严重并发症,5例(71.4％)出现轻微并发症.清扫淋巴结4～47个,平均12个,1例发现转移.中位随访时间24(5～81)个月,6例存活,肿瘤无复发,1例患者术后81个月时死于肿瘤复发.结论 ⅣA期胸腺瘤目前推荐的治疗方式是包括手术和放化疗在内的综合治疗.对于经过选择的患者手术治疗是安全有效的,患者可获得长期生存.应根据疾病进展程度和患者状况选择合适的手术方式.     

Ⅰb2～Ⅱa期宫颈癌根治性子宫切除术前子宫动脉栓塞化疗及髂内动脉前干支化疗的疗效比较

目的 探讨Ⅰb2～Ⅱa期宫颈癌根治性子宫切除术前不同动脉化疗方式的近期及远期疗效.方法　将151例患者分为研究组和对照组,研究组113例采取子宫动脉栓塞化疗术,对照组38例采取髂内动脉前干支化疗,术后2～4周内行根治性子宫切除术,观察化疗后2周内肿瘤变化及根治性子宫切除术后2、5年生存率.结果 介入术前测量肿瘤最大径平均为(4.58±0.37)cm,介入术后最大径平均值(2.11±0.24)cm.在研究组和对照组完全有效率分别为31.9%和21.1%;总有效率为94.7%(107/113)和76.3%(29/38),2周内疗效研究组明显好于对照组(P值均＜0.01).两组手术切缘均未见癌浸润,研究组3例切缘见脉管转移,5例见宫旁浸润,盆腔淋巴结转移6例;对照组1例切缘脉管转移,2例宫旁浸润,1例盆腔淋巴结转移.研究组2年生存为68/84,5年生存为47/64;对照组2年生存26/32,5年生存18/24.两组2年及5年生存率比无明显差异(P值均＞0.05).结论 子宫动脉化疗栓塞术短期内使宫颈癌肿瘤明显缩小,有利于外科手术剥离,近期疗效好于髂内动脉前干化疗,远期疗效无差异,是Ⅰb2～Ⅱa期宫颈癌的首选新辅助动脉化疗方式.     

微波消融治疗结直肠癌根治术后肝转移患者的疗效分析

目的 评价微波消融(MWA)在结直肠癌根治术后肝转移治疗中的作用,评估局部疗效及各因素对远期预后的影响.方法 回顾性统计2010年1月至2011年12月接受超声引导下MWA术治疗的106例结直肠癌根治术后肝转移患者的临床资料.观察术后完全消融率、并发症和局部肿瘤进展,计算术后总体生存率和无瘤生存率,并行生存率相关影响因素分析.结果 106例患者共消融215枚肿瘤,首次消融后209枚达到完全消融(97.2％);严重并发症发生率2.8％(3/106).截至随访结束,局部肿瘤进展率6.6％ (7/106);术后中位生存时间35个月;1、3、5年总体生存率和无瘤生存率分别为87.7％ 、50.0％、33.0％和55.7％、21.7％、5.7％.亚组分析显示,肿瘤最大直径≤3 cm的患者5年生存率为35.1％,＞3 cm的患者5年总生存率为27.3％,差异无统计学意义(P=0.077),化疗组5年生存率为38.9％,显著高于未化疗组的10.0％(P=0.003),肝内单发转移瘤患者5年生存率为50.9％,显著高于多发转移瘤患者的16.8％ (P=0.000).结论 MWA在直径≤6 cm肝转移瘤的治疗中,即使肿瘤直径较大,在完全消融后也能得到与直径较小的肿瘤相似的局部疗效和远期预后;MWA联合化疗能提高结直肠癌肝转移患者的远期预后,效果优于仅接受MWA;是否接受化疗、肝转移瘤数量及原发病灶手术切除时的Dukes分期是生存率的独立危险因素.     

肝癌切除术后复发患者行肝移植后移植肝再发肝癌的治疗对策——一例长期存活病例报道并相关文献复习

目的总结原发性肝癌切除术后复发患者行肝移植后新肝再发肝癌的治疗经验。方法 2003年11月14日空军总医院肝胆外科为1例肝癌切除术后复发患者施行了同种异体原位肝移植。肝移植术后（以下简称术后）3个月时曾返院化疗。术后19个月时发现移植肝首次出现肝癌复发,随后依次施行经皮肝穿刺射频消融、肝动脉化疗栓塞、术中射频消融及肝左内叶肿瘤切除术等序贯综合治疗。术后32个月时发现移植肝再次复发肝癌,依次给予经肝动脉化疗栓塞、术中肝右前叶肿瘤射频治疗及肝右后叶肿瘤切除等综合治疗。术后5年时发现门静脉血栓,出现肝功能异常,经保肝、抗凝、补充白蛋白等治疗后肝功能逐渐恢复。患者肝移植围手术期及术后接受常规抗乙肝病毒治疗。术后常规服用抗排异药物。结果该患者肝移植手术及术后恢复较为顺利。肝移植术后2次肝癌复发均成功治愈,第2次复发治愈后无肿瘤复发。乙肝病毒脱氧核糖核酸定量均小于103copies/ml,患者至今仍然健康生存,肝功能基本正常。结论对原发性肝癌切除术后肝癌复发的病例,只要复发肝癌符合中国杭州标准,仍应积极进行肝移植。对于肝移植术后新肝复发肝癌的患者,积极的序贯综合治疗及手术切除仍可能获得治愈。     

Volumetric parameters on FDG PET can predict early intrahepatic recurrence-free survival in patients with hepatocellular carcinoma after curative surgical resection

Purpose

This study assessed the prognostic values of volumetric parameters on ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in predicting early intrahepatic recurrence-free survival (RFS) after curative resection in patients with hepatocellular carcinoma (HCC).

Methods

A retrospective analysis was performed on 242 patients with HCC who underwent staging FDG PET and subsequent curative surgical resection. The tumor-to-non-tumorous liver uptake ratio, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the HCC lesions on PET were measured. The prognostic values of clinical factors and PET parameters for predicting overall RFS, overall survival (OS), extrahepatic RFS, and early and late intrahepatic RFS were assessed.

Results

The median follow-up period was 54.7 months, during which 110 patients (45.5%) experienced HCC recurrence and 62 (25.6%) died. Patients with extrahepatic and early intrahepatic recurrence showed worse OS than did those with no recurrence or late intrahepatic recurrence (p < 0.001). Serum bilirubin level, MTV, and TLG were independent prognostic factors for overall RFS and OS (p < 0.05). Only MTV and TLG were prognostic for extrahepatic RFS (p < 0.05). Serum alpha-fetoprotein and bilirubin levels, MTV, and TLG were prognostic for early intrahepatic RFS (p < 0.05) and hepatitis C virus (HCV) positivity and serum albumin level were independently prognostic for late intrahepatic RFS (p < 0.05).

Conclusion

Intrahepatic recurrence showed different prognoses according to the time interval of recurrence in which early recurrence had as poor survival as extrahepatic recurrence. MTV and TLG on initial staging PET were significant independent factors for predicting early intrahepatic and extrahepatic RFS in patients with HCC after curative resection. Only HCV positivity and serum albumin level were significant for late intrahepatic RFS, which is mainly attributable to the de novo formation of new primary HCC.

     

Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term results

The aim of this study was to evaluate the effectiveness and the safety of percutaneous radiofrequency (RF) thermal ablation of hepatocellular carcinoma (HCC) in 88 patients with a long follow-up, and to compare conventional electrodes and expandable electrodes. Eighty-eight patients with 101 hepatocellular carcinoma nodules (≤ 3.5 cm in diameter) underwent RF thermal ablation by means of either conventional electrodes or an expandable electrode. Therapeutic efficacy was evaluated with dynamic contrast CT, serum α-feto protein level, US examination at the end of the treatment, and during follow-up. Complete necrosis was obtained in all tumor nodules in a mean number of 3.3 sessions (tumor treated by conventional electrodes) or 1.5 sessions (tumor treated by expandable electrode). The mean follow-up was 34 months; overall survival rate was 33 % at 5 years. Disease-free survival at 5 years was 3 %; local recurrence rate was 29 % in patients treated with conventional electrodes; 14 % in patients treated with the expandable electrode. Two major complications and 14 minor complications were observed. Radiofrequency thermal ablation in small HCC is very effective with a low percentage of major complications. The use of an expandable electrode substantially reduced the number of treatment sessions but did not modify the overall survival rate and the disease-free survival rate. Received: 7 January 2000 Revised: 19 July 2000 Accepted: 11 August 2000     

基于动态对比增强MRI的肿瘤血流动力学及形态学特征预测乳腺癌术后复发时间的价值

目的探讨乳腺癌患者术前经常规动态对比增强MRI(DCE-MRI)扫描后获得的肿瘤血流动力学及形态学特征预测术后复发时间的价值。方法回顾性分析2012年11月至2014年12月辽宁省肿瘤医院术后复发的乳腺癌患者58例,依据复发时间分为早期复发(术后≤2年)组33例,晚期复发(术后>2年)组25例。所有患者均在术前行常规DCE-MRI扫描,通过计算机提取肿瘤三维容积内的血流动力学特征及在每一个期相下的肿瘤形态学特征及纹理特征。早期复发组和晚期复发组患者间计数资料和计量资料的比较分别采用Fisher精确概率法和Mann-Whitney U检验,绘制受试者操作特征(ROC)曲线,应用多元logistic回归计算特征联合预测早期复发与晚期复发的诊断效能。应用Kaplan-Meier法分析生存预后,并用Log-Rank检验比较各组生存曲线的差异。结果早期复发组和晚期复发组患者背景实质强化、病灶边缘、病灶内部强化特征、病灶形态、时间信号曲线类型和全乳血管增加程度的差异均无统计学意义(P均>0.05);2组患者的对比剂最大浓度值(Max Conc)、时间信号曲线下面积(AUC)及时间信号曲线最大斜率值(Max Slope)值差异有统计学意义(P<0.05)。对比分析8期DCE-MRI影像组学特征参数,第3期形态特征参数球度(sphericity)在早期复发与晚期复发组间差异有统计学意义(P=0.03)。AUC、Max Conc、Max Slope和第3期形态特征参数球度预测早期与晚期复发的ROC曲线下面积分别为0.664、0.659、0.684、0.670,上述4个参数联合预测的ROC曲线下面积为0.765,特异度为63.6%,灵敏度为84.0%,预测效能高于单变量。58例患者随访时间17~64个月,中位随访时间47个月。早期复发组的无进展生存和总生存均明显低于晚期复发组,差异有统计学意义(P<0.05)。结论基于术前无创性常规DCE-MRI获取的肿瘤血流动力学特征联合形态学特征预测乳腺癌患者的术后复发时间有一定的价值。     

Radiofrequency ablation of hepatocellular carcinoma: long-term outcome and prognostic factors

PURPOSE: To investigate the efficacy of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC), and the prognostic factors for post-RFA survival rate. METHODS: From 1999 to 2006, 266 patients with 392 HCCs underwent ultrasound guided RFA treatment. They were 216 males and 50 females, average age 59.4+/-15.4 years (24-87 years). The HCC were 1.2-6.7 cm in diameters (average 3.9+1.3 cm). There were 158 patients with single tumor, and the rest had multiple (2-5) tumors. Univariate and multivariate analysis with 19 potential variables were examined to identify prognostic factors for post-RFA survival rate. RESULTS: The overall post-RFA survival rates at 1st, 3rd, and 5th year were 82.9%, 57.9% and 42.9%, respectively. In the 60 patients with stage I HCC (AJCC staging), the 1-, 3-, 5-year survival rate were 94.8%, 76.4% and 71.6%, significantly higher than the 148 patients with stage II-IV tumors (81.8%, 57.6% and 41.2%, P=0.006). For the 58 patients with post-surgery recurrent HCC, the survival rates were 73.2%, 41.9% and 38.2% at the 1st, 3rd, and 5th year, which were significantly lower than those of stage I HCC (P=0.005). Nine potential factors were found with significant effects on survival rate, and they were number of tumors, location of tumors, pre-RFA liver function enzymes, Child-Pugh classification, AJCC staging, primary or recurrent HCC, tumor pathological grading, using mathematical protocol in RFA procedure and tumor necrosis 1 month after RFA. After multivariate analysis, three factors were identified as independent prognostic factors for survival rate, and they were Child-Pugh classification, AJCC staging and using mathematical protocol. CONCLUSION: Identifying prognostic factors provides important information for HCC patient management before, during and after RFA. This long-term follow-up study on a large group of HCC patients confirmed that RFA could not only achieve favorable outcome on stage I HCC, but also be an effective therapy for stage II-IV or recurrent HCC.     

Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation

PURPOSE: To perform a prospective, intention-to-treat clinical trial to determine the long-term survival rates of patients with hepatic cirrhosis and early-stage hepatocellular carcinoma (HCC) in whom percutaneous image-guided radiofrequency (RF) ablation was used as the sole first-line anticancer treatment. MATERIALS AND METHODS: The study was performed with approval of the ethics committee, and written informed consent was obtained for all patients. From June 1, 1996, to January 1, 2003, 206 patients (143 men, 63 women; age range, 51-81 years; mean age, 67 years +/- 7) who were excluded from surgery and who had Child class A or B cirrhosis with either a single HCC less than or equal to 5 cm in diameter or multiple (as many as three) HCCs less than or equal to 3 cm in diameter each were enrolled. RF ablation was performed in 187 (91%) of 206 patients; 19 (9%) were excluded from RF treatment because of unfavorable tumor location. Follow-up ranged from 3 to 78 months (mean, 24 months +/- 21) and included measurement of alpha-fetoprotein level, ultrasonography at 3-month intervals, and spiral computed tomography at 6-month intervals. Patients were observed for recurrence of the treated tumor and for the emergence of new HCC tumors. Survival probabilities were estimated with the Kaplan-Meier method, and differences between survival curves were evaluated with the log-rank test. RESULTS: At the end of the study, 145 patients were alive, and 61 were dead. In the intention-to-treat analysis, overall survival rates were 97% at 1 year, 67% at 3 years, and 41% at 5 years. Median survival was 49 months. In the 187 patients treated with RF ablation, overall survival rates were 97% at 1 year, 71% at 3 years, and 48% at 5 years. Median survival was 57 months. The difference between the two survival curves was not statistically significant (P=.5094). Survival of patients treated with RF ablation was dependent on Child class (P=.0006) and tumor multiplicity (P=.0133). Patients who had Child class A cirrhosis with solitary HCC (n=116) had 1-, 3-, and 5-year survival rates of 100%, 89% and 61%; median survival was 65 months. The 1-, 3-, and 5-year recurrence rates were 14%, 49%, and 81% for the emergence of new tumors and 4%, 10%, and 10% for local tumor progression. CONCLUSION: RF ablation is an effective first-line treatment for cirrhotic patients with early-stage HCC who were excluded from surgery.     

Intrahepatic recurrence after percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of the pattern and risk factors

PURPOSE: To evaluate the pattern and risks for intrahepatic recurrence after percutaneous radiofrequency (RF) ablation for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: We studied 62 patients with 72 HCCs (< or =4 cm) who were treated with percutaneous RF ablation. The mean follow-up period was 19.1 months (6.0-49.1). We assessed the incidence and cumulative disease-free survival of local tumor progression (LTP) and intrahepatic distant recurrence (IDR). To analyze the risk factors, we examined the following, for the LTP: (1) tumor diameter, (2) contact with vessels, (3) degree of approximation to hepatic hilum, (4) contact with hepatic capsule, (5) presence of ablative safety margin, (6) degree of benign periablational enhancement and (7) serum alpha-fetoprotein; for the IDR: (1) severity of hepatic disease, (2) presence of HBsAg, (3) serum alpha-fetoprotein, (4) whether RF ablation was the initial treatment and (5) multiplicity of tumor for IDR. RESULTS: The incidence of overall recurrence, LTP and IDR was 62.9%, 26.4% and 53.2%, respectively. The cumulative disease-free survival rates were 52%, 82% and 56% at 1 year, 26%, 63% and 30% at 2 years, respectively. Univariate analysis showed that the significant risk factors for LTP were: a tumor with a diameter >3 cm, contact of HCC with a vessel and an insufficient safety margin (p<0.05). A multivariate stepwise Cox hazard model showed that the measurement of a tumor diameter >3 cm and insufficient safety margin were independent factors. Only the increased serum alpha-fetoprotein was a significant risk factor for IDR (p<0.05). CONCLUSION: Intrahepatic recurrence after percutaneous RF ablation is common. Large HCC (>3 cm) with high serum alpha-fetoprotein should be treated more aggressively because of higher risk for recurrence.     

直肠癌Miles手术后局部复发原因及治疗

目的探讨直肠癌Miles术后局部复发的原因及防治。方法1986年1月-2006年12月共行直肠癌Miles手术218例．对其中术后局部复发35例的临床情况进行回顾性分析。结果局部复发35例中男26例，平均年龄比首次手术组低5岁，DukesC期25例，组织学高度恶性19例，22例肿瘤距肛门3-6cm。复发再手术14例，5年生存率为27．2％（4／14），中位生存期25．4个月（5—144个月）；单纯放化疗21例，中位生存期11．7个月（3—29个月），未手术者均在3年内死亡。结论术后局部复发与年龄、性别、病期、病理类型、肿瘤部位及根治是否彻底密切相关。预防复发宜做好首次手术。对复发病例力争早发现，并予再次手术为主的综合治疗，以延长生存期。     

腹腔镜辅助超声引导下射频消融治疗膈顶部原发性肝细胞癌疗效评价

目的 探讨腹腔镜辅助超声引导下射频消融治疗膈顶部原发性肝细胞癌的可行性、安全性及有效性.方法 解放军总医院肝胆外科2013年1月至2016年3月连续收治的膈顶部单发原发性肝细胞癌患者23例,所有患者采用腹腔镜辅助超声引导下射频消融治疗,观察围术期并发症发生情况并随访长期疗效.结果 23例患者均成功施行腹腔镜辅助超声引导下射频消融治疗,所有患者围术期均无大出血、胆瘘、重度胸腔积液、血气胸等严重并发症发生,术后2～3d CT检查提示消融区完全覆盖肿瘤,随访9～38个月患者总体生存情况令人满意.结论 腹腔镜辅助超声引导下射频消融治疗膈顶部原发性肝细胞癌具有可操作性,并且安全有效.     

A Clinical Investigation into the Factors Influencing the Prognosis of Patients with Primary Liver Cancer after Hepatectomy

To explore the factors influencing the prognosis of patients with primary liver cancer(PLC) after hepatectomy on purpose to provide the preventive measures for improving the long-term effect. Methods All of the 189 patients who underwent hepatectomy with PLC from May, 1994 to January, 1998 were included by reviewing their clinical pathological characteristics and treatments. Totally, 22 factors contributed to the long-term survival rate( SR) and the disease-free SR were analysed . All patients were followed up at least 5 years. Results The 3- and 5-year cumulative SRs in the total group were 63% and 45% respectively. The 3- and 5-year SRs and disease-free SRs in the curative resection (CR) group ( n = 162 ) were 67% ,47%, and 45% and 26% respectively. It was showed that the way by which a tumor was found, tumor size, portal thrombi, satellite nodule, cirrhosis type, TNM stage, tumor envelopo, recurrence and treatment, vascular exclusion and transfusion, differentiation grade and CR were prognostic factors by individual variable analysis. A multivariable analysis showed that CR , tumor size and reoporation were significant factors associated with the prognosis. Conclusion The type of CR and tumor size are determinants influencing the prognosis. Early diagnosis of small carcinoma and CR as soon as possible is essential to improving the prognosis of PLC. Avoiding transfusion and controlling the progress of cirrhosis are expected to improve the discase-free SR.     

Transarterial chemoembolization in very early and early-stage hepatocellular carcinoma patients excluded from curative treatment: a prospective cohort study

Aim

To assess clinical outcome of transarterial chemoembolization (TACE) in a series of patients with early-stage hepatocellular carcinoma (HCC), within Milan criteria, but clinically unfit for liver transplantation (OLT).

Methods

From January 2006 to May 2009, 67 patients (43 males, mean age 70 ± 7.6 years) with very early or early-stage unresectable HCC, within Milan selection criteria but clinically unfit for OLT, underwent TACE. The primary endpoint of the study was overall survival. Secondary endpoints were: safety, liver toxicity, 1-month tumour response according to the amended RECIST criteria, time to local and distant intrahepatic tumour recurrence and time to radiological progression.

Results

Two major periprocedural complications occurred (3%), consisting of liver failure. Periprocedural mortality rate was 1.5% (1 patient). A significant increase in ALT and bilirubin levels 24 h after treatment was reported, with progressive decrease at discharge. At 1-month follow-up, complete and partial tumour response rates were 67.2% and 29.8%, respectively, with two cases of progressive disease. Mean follow-up was 37.3 ± 15 months. The 1-, 2-, and 3-year overall survival rates were 90.9%, 86.1%, and 80.5%, respectively. Median expected time to local tumour recurrence and intrahepatic tumour recurrence were 7.9 and 13.8 months, respectively. Radiological disease progression was observed in 12 patients (17.9%) with a mean expected time of 26.5 months.

Conclusion

In patients with early-stage HCC, clinically excluded from OLT and unfit for surgery or percutaneous ablation, TACE is a safe and effective option, with favourable long-term survival.