肝细胞癌的外科治疗

肝细胞癌的外科治疗廖传佳，刘允怡肝细胞癌或肝癌为世界上最常见的癌症，占肝新生物的９０％和所有癌症的１０％。它可能是最常见的男性恶性肿瘤，每年有一百万人死于该病。肝细胞癌发生率（每１０万男性／年）在加拿大、法国、大不列颠和澳大利亚南部少于２例，新加坡为...     

肝细胞癌综合治疗选择与策略

肝细胞癌的治疗包括手术切除、肝动脉化疗栓塞（TACE）和局部消融等多种方法。肝脏功能和肿瘤状况是决定是否可行手术的最主要的2个因素。合并门静脉、胆管癌栓仍应积极争取手术。除手术外,肝移植和局部消融是另两种根治性治疗方法,目前一般用于符合Milan标准的早期肝癌（单发肿瘤,直径≤5cm;多发肿瘤,数目≤3个,最大直径≤3cm）。前者要求肝功能失代偿,后者要求肝功能Child—PutghA、B级且不适合手术切除。TACE是不适合根治性治疗的中晚期肝癌的首选方法,选择性的与手术、射频消融、放疗、索拉非尼联用以提高疗效。局限性肝内病灶而又不适合局部消融的肝细胞癌可使用放疗,尤其是肝外转移灶。索拉非尼目前仍主要用于晚期肝细胞癌。免疫治疗是肝细胞癌辅助治疗方法。充分了解各种治疗方法特点,把握适应证,合理综合治疗肝细胞癌,以提高肝细胞癌整体疗效。     

生物治疗在肝细胞癌中的应用

生物治疗在解决治疗肝细胞癌(HCC)所面临的难题方面具有独特的优势[1]。尤其是在与其它治疗方法综合应用时,更显示出其良好的应用前景。一、细胞因子用于肝细胞癌免疫治疗的细胞因子有白介素 2(IL 2)、IL 12、干扰素(IFN)、肿瘤坏死因子(TNF)等。但目前临床在预防 HCC根治切除术后复发或治疗不可切除中晚期 HCC时多与介入治疗联合应用[2]。黎洪浩[3]等应用肝动脉栓塞化疗(TACE)和门静脉化疗(PVC)联合 IFN治疗 33 例根治性切除HCC,对照组 42 例单行 TACE 和 PVC,比较两组外周血T细胞亚群和术后 1、2、3 年复发率。结果显…     

HBVx在肝细胞癌中的研究进展

肝细胞癌（HCC）的发生和发展与HBVX蛋白（HBx）的多种生物学功能密切相关,但HBV与原发性肝癌之间的特异关系仍未完全阐明,HBV慢性感染肝细胞的过程为HBV DNA整合于肝细胞DNA之中[1-2],如果其DNA整合在肝细胞DNA的原癌基因附近,可导致这些原癌基因的激活[3].因此,HBx及其编码基因的研究可揭示HCC发生和发展的机制.通过分析病毒基因组转化活性和病毒DNA推测,病毒DNA自身具有病毒癌基因,并且发现其产物x蛋白或HBx Ag具有反式激活功能.随着HBVx基因（HBx）研究的不断深入,同时还发现其可与抑癌基因产物P蛋白相互作用[4-5].HBx基因及其产物在原发性肝癌发生过程中起着十分重要的作用[6-7].对HBx的全面了解,将有助于对HBV致癌机理的认识.     

外科综合治疗对肝细胞癌合并门静脉癌栓的疗效观察

目的探讨外科综合治疗对肝细胞癌合并门静脉癌栓的疗效。方法2000年1月至2003年1月，36例肝癌伴门静脉癌栓病人根据外科治疗方法不同而分为3组：切除 TACE 胸腺肽(A组，n=9)，切除 TACE(B组，n=20)和切除组(C组，n=7)。回顾分析这3组病人的中位生存期和不同分型癌栓(Ⅰ～Ⅳ型)治疗后的疗效。结果A、B、C3组病人的中位生存期分别为10．0个月、7．0个月和8．0个月，各组差异无显著性意义(P=0．1240)。就癌栓分型而言，外科综合治疗有助于提高Ⅰ型癌栓病人的生存期。结论外科综合治疗有助于提高肝癌合并门静脉癌栓病人的生存期，尤其是癌栓位于门静脉二级以上的病人。     

胆管内生长的原发性肝细胞癌的外科治疗

临床上原发性肝细胞癌胆管内生长的病例较少见 ,由于其生长方式的特殊 ,其临床表现较其他生长方式的肝细胞癌有所不同 ,诊治亦带来一定的困难。现就我院 2例胆管内生长的肝细胞癌的外科治疗作一分析。1　临床资料病例 1:男 ,6 5岁 ,住院号 :87390。因反复上腹痛伴黄疸一月 ,外院味 :胆囊结石、肝外胆管扩张、胆总管下端梗阻、肿瘤可能。于 1990年 6月 5日行胆囊切除 +肝活检 +胆总管切开探查 +T管造影术 ,术中见肝肿大 ,表面呈结节状改变 ,胆囊床近肝膈面有一 3cm直径之包膜块状物 ,取之冰冻病理报告示 :纤维组织。术中胆道造影未见明显异…     

肝细胞癌(综合报道)

肝细胞癌常存在两种疾病的问题，一是癌肿本身，另一是肝硬化，后者限制了肝癌的治疗性切除。本文对肝细胞癌的流行病学、危机因素以及近期有关其诊治上的进展作一综合报道。     

Surgical treatment of hepatocellular carcinoma

Local tumor control is still the most important consideration in the treatment of hepatocellular carcinoma (HCC). Surgical treatments, including liver resection and liver transplantation are, and will remain, the first-line therapeutic strategies for local control in patients with primary HCC. Although aggressive liver resection is often performed for advanced HCC in patients with a large tumor, multiple tumors, or tumors with vascular invasion, liver transplantation is the preferred option, after taking into consideration age and tumor-related factors, when there is poor liver functional reserve. Preventing deterioration in liver function is the second priority in the treatment of HCC. When performing liver resection, extensive removal of noncancerous liver parenchyma during lobectomy or hemihepatectomy, should be avoided as much as possible. Anatomic resection, which refers to systematic elimination of the main tumor with its minute metastases, preserves liver function and is highly recommended. A treatment algorithm based on published evidence is now available, which helps us decide on the most suitable therapeutic option for individual patients, depending on the tumor characteristics and liver functional reserve.     

肝癌的多模式治疗

原发性肝癌是最常见的肝癌,发病率逐年上升,目前已成为全世界癌症相关死亡的第三大病因。尽管原发性肝癌的临床诊断和治疗在过去的几十年中显著改善,但是其预后仍然较差。我们依据巴塞罗那分期系统,不同的外科手术、放射超声介入和非介入治疗被确定为肝癌的多模式治疗。BCLC系统被用来作为决策指南,但是它在决定患者治疗方法方面有一定的局限性,我们应该为每个患者提供个体化的治疗,而不是完全根据指南确定。本篇综述对目前肝癌的常见治疗进行总结。     

Surgical treatment of hepatocellular carcinoma

Experience of surgical treatment of 171 patients, suffering hepatocellular carcinoma (HCC), was summarized. Extensive hepatic operations were performed in 99 (71.2%) patients, of them in 22.2%--on the concurrent hepatic cirrhosis background. Late results of treatment, depending on the main prognostic factors present, were analyzed. Cumulative survival in the terms of 5, 10 and 20 years have constituted 53.5, 37.3 and 28.8% accordingly. Accomplishment of a radical hepatic resection for HCC permits to achieve a durable remission of a tumoral process. While revealing a concurrent hepatic cirrhosis stage B (according to Child--Pugh classification) it is appropriate to use a hepatic transplantation and other methods of treatment, including chemoembolization, radiofrequency ablation, chemotherapy.     

Surgical treatment of hepatocellular carcinoma

There are two principal aspects to surgical treatment of hepatocellular carcinoma, hepatectomy and transplantation. Transplantation is a treatment of the tumor and the underlying liver disease. When discovered in a liver, hepatocellular carcinoma is often seen as a large tumor. Resection is indicated if there is no bilobar diffusion or metastasis. If the liver is , liver resection is contraindicated in case of liver failure or atrophy. In patients with no liver failure (Child-Pugh A), bi-segmentary resection can be proposed. In the long run, the causes of mortality after resection for hepatocellular carcinoma are mainly subsequent to tumor recurrence. Transplantation is a priori the best possible treatment for small sized hepatocellular carcinoma developing on a chronically ill liver. For several reasons, this option cannot however be proposed for all patients: limited number of liver grafts available, high operative mortality around 10%. In addition, the risk of recurrence of the causal liver disease, particularly in case of hepatitis B and C infections, is high. Finally, even if the initial tumor is a unique small-sized lesion, the risk of recurrence is favored by the immunosuppression required for tolerance after liver transplantation.     

非手术方式治疗大肝癌及巨大肝癌的研究进展

肝癌是世界范围内最常见的恶性肿瘤之一.我国是乙型肝炎和肝癌的高发国.据统计全球每年新增原发性肝细胞癌至少70万例,我国病例数占一半[1].由于早期无特异性表现,很多患者中晚期才被确诊,手术切除难以获得良好疗效.随着治疗理念的改变与治疗技术的进步,制定个性化治疗方式已经成为21世纪肝癌治疗的主要趋势.本文简要回顾近20年...     

Systemic treatment for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most frequent malignancies worldwide. A variety of pharmacological strategies has been evaluated in the treatment of HCC: classical chemotherapy, tamoxifen, octreotide, thymostimulin, pravastatin, (131)I-lipiodol as well as transarterial chemoperfusion (TAC) and chemoembolisation (TACE). TACE monotherapy or TACE combined with pravastatin resulted in a survival benefit of selected HCC patients. New strategies such as immunotherapy, antiangiogenic agents or cyclooxygenase inhibitors are under clinical investigation and might play a role in future therapies for HCC. Efficient strategies for the primary prevention of HCC are available and promising concepts in the secondary prevention have been reported.     

巨大肝癌的外科治疗

目的 探讨巨大肝癌(直径≥10cm)手术切除的安全性、可行性和治疗结果。方法 分析我院手术治疗大肝癌103例的效果。比较巨大肝癌与直径＜10cm一般肝癌切除组(34例)、以及巨大肝癌的切除组(68例)和非切除组(35例)的手术并发症、生存率。结果 巨大肝癌切除组与一般肝癌切除组的手术时间与出血量均无明显差异，手术并发症、死亡率三组间也无差异。一般肝癌组、巨大肝癌切除组与非切除组术后1、3、5年生存率分别为78．64％、53．73％、23．76％；72．8％、47．84％、21．26％及32．56％、11．37％、5．45％。后两者差异有显著的统计学意义(P＜0．05)。结论 对巨大肝癌的手术切除应持积极态度，一期切除能获得良好的治疗效果，如同时施行综合治疗可提高巨大肝癌远期疗效。     

大肝癌的外科治疗策略

Hepatocellular carcinoma (HCC) with a diameter > 5 cm is defined as large HCC. Hepatic resection is the first choice for solitary large HCC with intact capsule and without satellite nodules. The key to successful large HCC resection is to judge the resectability and estimate the remnant liver function preoperatively. Moreover, the liver must be exposed and dissociated adequately, and familiarity with the anatomy of the liver is crucial. Choosing the right technique of hepatic blood flow occlusion and avoiding excessive resection of the liver are important elements. Special attention should be paid to the efficacy of liver transplantation for patients with large HCC exceeding Milan criteria, h is advisable to resect large HCC actively.The hepatic resection is safe and feasible in selected patients with large HCC.     

大肝癌和巨大肝癌外科治疗策略

肝细胞癌（简称肝癌）是全球第5位常见恶性肿瘤,疗效差,总的5年平均生存率只有7％左右。在我国,肝癌表现为两大显著特征,一是90％以上合并有较明显的肝硬化;二是80％的患者就诊时肿瘤已长得很大,属大肝癌或巨大肝癌,约占临床确诊肝癌患者的75％。所谓大肝癌是指肿瘤直径〉5cm的肝癌,巨大肝癌则是指肿瘤直径〉10cm的肝癌。大肝癌和巨大肝癌与小肝癌的区别不仅在于其生物学特性,其临床特性亦有诸多的不同：（1）大肝癌和巨大肝癌易发生扩散转移,特别是肝内的微小癌灶。是术后短期内复发的主要原因。     

Multi-modality treatment of non-small cell lung cancer

Despite significant advances in radiation therapy techniques and a variety of newer chemotherapeutic agents, when multimodality treatment for stage I and II tumors has been tested by Phase III randomized prospective trials of adequate size, no significant survival advantage over surgery alone has been found in most instances. Modalities tested include preoperative radiation therapy, and postoperative chemotherapy and radiation therapy. Trials are presently underway to test preoperative chemotherapy for stages Ib, II, and T3NI (S9900) and to test adding surgery for patients with N2 disease who have been treated by chemotherapy and radiation therapy (INT 0139). Results of a recently completed trial (JBR10) will answer the question of whether postoperative chemotherapy is of benefit for patients with stages T2N0 or T1-2N1. Until these trials are completed, surgeons should resist the temptation to use newer but unproven therapies except within established approved protocols.