肝癌术中腹腔内游离癌细胞与术后种植转移的相关性分析

目的 分析肝癌术中腹腔内游离癌细胞数量与术后种植转移发生率的相关性,为肝癌术后种植转移的早期诊断、预测和预防奠定理论基础.方法 收集128例原发性肝癌患者术中的腹腔灌洗液,采用流式细胞仪DNA倍体分析技术计数其中的肝癌细胞数量,并对术后腹腔内种植转移情况进行随访.结果 肝癌术中腹腔灌洗液中游离癌细胞计数与术后腹腔内种植转移的发生率存在一定的相关性(γ=0.628),其中术中肝癌破裂组、肝癌部分切除组、肝癌自发破裂组为术后发生种植转移的高危组.结论 肝癌术中腹腔内游离癌细胞数量对术后种植转移的发生率有一定的预测作用,通过采取有效的措施以减少肝癌术中腹腔内游离癌细胞对术后种植转移的发生有一定的预防作用.     

肝癌切除术序贯腹腔热灌注化疗在肝癌自发性破裂出血中的临床应用

背景与目的 肝癌自发性破裂出血（SRHCC）是肝癌严重并发症之一。针对SRHCC治疗,首选简单有效的方法快速止血,然后在全身及局部状况允许的情况下进一步治疗,以期挽救患者生命及延长患者生存。本研究探讨肝癌切除序贯腹腔热灌注化疗（HIPEC）在SRHCC中的临床应用价值。方法 回顾性分析玉溪市人民医院肝胆外科2013年5月1日—2021年12月1日期间收治的102例SRHCC患者的临床资料。其中48例行肝切除术序贯HIPEC治疗（观察组）,54例行单纯肝切除术治疗（对照组）。比较两组患者的相关临床指标。结果 两组患者术前一般资料、主要手术指标、术后病理、住院时间、腹腔引流管术后留置时间、Clavien-Dindo 2级以上并发症发生率和围手术期病死率、复发后再手术率差异均无统计学意义（均P>0.05）。观察组住院总费用、术后累积无瘤生存率及总生存率均高于对照组（均P<0.05）,但腹膜种植转移发生率明显低于对照组（P<0.05）。结论 肝切除序贯HIPEC能降低SRHCC术后腹膜种植转移率,改善术后无瘤生存率及累积总生存率,是一种安全有效治疗方式,具有重要临床应用价值,但具有费用较高的缺点。     

氟尿嘧啶植入剂预防肝癌破裂术后腹腔种植的临床研究

目的 研究氟尿嘧啶植入剂对预防肝癌破裂术后肿瘤腹腔种植转移的临床疗效.方法 12例在肝癌破裂出血手术切除后,将氟尿嘧啶植入剂分别播撒于肝切除部位或断面、局部淋巴引流区域、网膜组织.术后随访复查CT以排除腹腔转移.结果 12例患者手术均成功,成功切除病灶,无手术死亡,7例行肝癌切除术,4例行规则性肝叶/段切除术(左肝外叶切除3例,第Ⅳ段切除1例),1例第八段肝癌侵犯膈肌,同时行肝肿瘤切除并部分膈肌切除术.平均随访14.3个月,1例患者术后6个月复查发现脾脏周围转移,其他11例患者均未发现有腹腔转移病灶,2例肝内复发.1例患者术后13个月死于肝外其他器官转移.结论 同国内同类研究相比较,氟尿嘧啶植入剂能显著减少肝癌破裂术后肿瘤腹腔种植转移.     

自发性肝细胞癌破裂的处理策略

世界不同国家和地区肝癌和肝癌破裂发生率差异很大。同肝癌一样,肝癌破裂病死率很高。肝癌破裂的原因,推论很多而且十分具有争议性。肝癌破裂的诊断主要通过临床和影像学检查,确诊率很高。肝癌破裂的治疗主要分为3个处理阶段:(1)急症阶段。主要通过复苏治疗,稳定病人和停止肝癌破裂出血。停止肝癌破裂出血的方法包括改善病人凝血功能障碍,介入治疗(肝动脉栓塞)和手术治疗(围肝脏纱布填塞、肝动脉结扎、使用能量器械或化学制剂直接止血和急症期肝部分切除术)。(2)评估阶段。病人肝癌破裂停止出血后进行评估,包括病人整体情况、肝功能、肿瘤分期、肝癌(包括肿瘤位置)能否切除、剩余肝脏体积情况、是否伴有肝硬化或门静脉高压症。(3)决定性治疗阶段。该阶段主要分为治愈性和非治愈性。由于肝癌破裂是肝移植的禁忌证,肝部分切除术是唯一治愈性手段。术中使用蒸馏水或5-氟尿嘧啶灌洗腹腔,可有效降低术后肝癌腹膜转移率。肝部分切除术可在急症期(出血期间),延迟早期(肝癌破裂时间≤8 d)或延迟晚期(肝癌破裂时间>8 d)施行。在急症期或延迟早期施行肝部分切除术,术后肝癌腹膜转移率比延迟晚期低。肝癌破裂停止出血后,对于无法施行肝部分切除术的病人,其治疗方法与没有肝癌破裂的病人无较大差别。在可施行肝部分切除术的病人中,手术是最好的治疗手段。肝部分切除术病人的远期生存率高于其他任何非手术治疗(包括经肝动脉栓塞或化疗栓塞)。     

急诊肝切除术治疗肝癌自发性破裂16例

目的：探讨急诊肝切除术治疗肝癌自发性破裂的适应证和疗效。方法：对16例肝癌自发性破裂患者行急诊肝切除术,其中男10例,女6例,平均年龄55.6岁,术前均行诊断性腹腔穿刺、B超和CT检查。术后1个月内均行TACE治疗。结果：急诊手术无死亡病例,术后并发症发生率25.0%（4/16）。术后1、3年生存率分别为81.25%、50.00%。结论：急诊左半肝切除术或左肝外叶切除术治疗肝癌自发性破裂可获得良好预后。     

择期腹腔镜肝切除术治疗肝癌破裂出血

目的探讨择期腹腔镜肝切除术治疗肝癌破裂出血的可行性。方法对1例肝癌破裂出血后自行停止的中年男性患者施行择期腹腔镜肝切除术,分析该患者的临床资料。结果患者接受了择期腹腔镜肝切除术,手术完整切除了肝脏病灶。手术顺利,手术时间为300 min,术中出血500 mL。患者术后恢复良好,无并发症发生,于术后4 d拔除腹腔引流管,于术后8 d康复出院。术后病理学检查证实是中分化肝细胞癌合并破裂出血。结论择期腹腔镜肝切除术治疗肝癌破裂出血对于特定的患者是安全可行的,但是此类手术需要由腹腔镜手术经验丰富的外科医生施行。     

腹腔热灌注化疗预防局部进展期胃癌患者根治术切除后腹膜转移的安全性评价

目的:局部进展期胃癌患者既使接受根治性手术,预后依然欠佳且易发生腹膜转移。腹腔热灌注化疗（HIPEC）可有效地清除或杀灭腹腔内游离的癌细胞或微小病灶,但当前预防性HIPEC在局部进展期胃癌患者中仍缺乏安全性评价。故本研究旨在探讨胃癌D 2根治术联合HIPEC在预防局部进展期胃癌腹膜转移中的安全性。 ...     

肝切除联合腹腔热灌注化疗在肝癌自发破裂出血中的应用

目的探讨肝切除联合腹腔热灌注化疗在肝癌自发破裂出血中的应用价值。方法回顾性分析2013年1月至2016年10月在中山市人民医院行肝切除联合腹腔热灌注化疗的20例肝癌自发破裂出血患者的临床资料。统计和分析患者的手术时间、术中出血量、术后并发症、术后住院时间及随访情况。结果患者均顺利完成手术,肿瘤切除后切缘均为阴性,患者无围手术期死亡。手术时间为(204±45)min;术中出血量为100~800 m L,平均270 m L;术后住院时间为(11±4)d。术后发生胸腔积液及腹腔积液各2例,经保守治疗治愈。1例于术后3个月肿瘤复发并死亡,其余恢复良好。结论肝切除联合腹腔热灌注化疗应用于肝癌自发破裂出血是安全、有效的,具有止血确切、防治肿瘤种植转移及复发的优势。     

手术联合腹腔热灌注化疗治疗儿童肝细胞癌破裂出血1例报告并文献复习

目的:探讨腹腔热灌注化疗(HIPEC)治疗儿童肝细胞癌自发破裂出血的安全性及可行性。方法:回顾性分析1例手术切除后联合腹腔热灌注化疗治疗儿童肝细胞癌破裂出血患者的临床与随访资料,并复习相关文献。结果:患儿,男,10岁,因肝内肿块破裂于外院行急诊介入栓塞止血治疗,6d后于湖南省人民医院肝胆外科接受胆囊切除+左半肝切除+HIPEC(5%葡萄糖溶液3000m L+吡柔比星10mg,41℃循环灌注40min),手术顺利,围手术期未出现并发症。术后病理结果证实为肝细胞肝癌III级及R0切缘。患儿随后转儿童血液肿瘤科,以FOLFOX4方案化疗。术后11个月复查示,甲胎蛋白9.56ng/m L,HBV-DNA100IU/m L,上腹部MRI未见肿瘤复发。结论:手术联合HIPEC治疗儿童肝细胞癌破裂出血是安全可行,近期效果满意。     

原发性肝癌自发性破裂大出血10例诊治体会

目的探讨肝癌自发性破裂大出血的诊治方法。方法回顾性分析10例肝癌破裂大出血的手术临床资料。结果10例均行手术切除出血的肝肿瘤,清除积血,清洗腹腔,腹腔内放置化疗药物,无术中死亡病例。结论原发性肝癌自发性破裂大出血复发率高。腹腔种植机会多,预后差,手术切除肿瘤为首选方法,术后应行综合治疗。     

Acute Intraperitoneal Rupture of Hydatid Cysts

Background Rupture into the abdominal cavity is a rare but serious complication of hydatid disease. The cysts may be ruptured after a trauma, or spontaneously as a result of increased intracystic pressure. Rupture of the hydatid cyst requires emergency surgical intervention. Methods Seventeen patients received surgical treatment for intraperitoneal rupture of the cysts over a period of 18 years. Age, gender, time to surgery from the onset of the symptoms, laboratory findings, diagnostic procedures, surgical treatment modalities, in-hospital stay, morbidity, mortality and recurrence were evaluated retrospectively. Results Five cases (29.4%) had a history of blunt abdominal trauma. Ultrasonography scans revealed intra-abdominal fluid in all cases. Intraperitoneal multiple cysts with heterogeneous cavity or cystic structures in the liver were shown in 14 cases. Computed tomography and magnetic resonance imaging showed multiple cystic lesions in the liver and peritoneum with intra-abdominal free fluid. Procedures to fill the cystic cavities were applied after removal of the intraperitoneal fluid. Four patients (23.5%) died in the early postoperative period. A total of nine morbidities developed in six patients (35.3%). Median hospital stay was 18 days and median follow-up was 78 months. Intra-abdominal recurrence occurred in one case (7.7%). Conclusions Rupture of hydatid cysts into the peritoneal cavity, although rare, presents a challenge for surgeons. This pathology should be included in the differential diagnosis of acute abdomen in endemic areas. Computed tomography scan, in addition to clinical presentation, is essential for diagnosis. Emergency surgery is the main treatment for acute ruptured hydatid cysts. The morbidity and mortality rates of surgical interventions for ruptured hydatid cysts are higher than the rates for elective uncomplicated cases.     

T4期结直肠癌根治术后早期腹腔热灌注化疗的临床研究

目的:探讨T4期结直肠癌患者根治术后早期行腹腔热灌注化疗(HIPEC)的可行性、安全性及短期临床疗效。方法:回顾性分析2011年1月—2013年6月收治的96例T4期结直肠癌患者资料,其中48例于术后第5~6天开始行HIPEC(1次/d,共3次),术后1个月内行第1次m FOLFOX6方案全身静脉化疗,共6疗程(HIPEC组);另48例仅行相同方案的全身静脉化疗(对照组)。比较两组患者的不良反应、并发症、术后1、2年复发率、生存率及生存质量情况。结果:HIPEC及全身静脉化疗均顺利完成;两组均无手术相关死亡,均未出现切口感染、吻合口瘘、粘连性肠梗阻等并发症。两组患者骨髓抑制、恶心呕吐、肝功能损害差异均无统计学意义(均P0.05);HIPEC组术后1、2年复发率均低于对照组(2.1%vs.20.8%;6.3%vs.31.3%,均P0.05);两组术后1年生存率差异无统计学意义(P0.05);HIPEC组术后2年生存率高于对照组(81.3%vs.58.3%,P0.05);HIPEC组生存质量评分升高比例明显高于对照组(75.0%vs.25.0%,P0.05)。HIPEC组中,结肠癌患者的中位生存时间长于直肠癌患者(32个月vs.18个月,P0.05)。结论:T4期结直肠癌患者根治术后早期行HIPEC可有效控制腹腔复发、转移,提高患者近期生存率及生存质量,无明显毒副作用,安全可行。     

Peritonealkarzinose

Colorectal cancer is a common malignant disease with increasing incidence and a significant cause of death in cancer patients. More than 10% of patients with colorectal cancer show peritoneal carcinomatosis at initial diagnosis. Moreover, peritoneal metastasis is a common sign of recurrence. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are a new treatment strategy for highly selected patients with peritoneal carcinomatosis. Numerous studies show prolonged survival after CRS and HIPEC with acceptable morbidity and mortality rates. Accurate preoperative diagnostics and patient selection play a pivotal role in postoperative patient outcome. This promising treatment strategy is discussed regarding surgical technique, intraperitoneal chemotherapy, and patient outcome.     

Peritoneal carcinomatosis. Surgical treatment, including hyperthermal intraperitoneal chemotherapy]

Colorectal cancer is a common malignant disease with increasing incidence and a significant cause of death in cancer patients. More than 10% of patients with colorectal cancer show peritoneal carcinomatosis at initial diagnosis. Moreover, peritoneal metastasis is a common sign of recurrence. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are a new treatment strategy for highly selected patients with peritoneal carcinomatosis. Numerous studies show prolonged survival after CRS and HIPEC with acceptable morbidity and mortality rates. Accurate preoperative diagnostics and patient selection play a pivotal role in postoperative patient outcome. This promising treatment strategy is discussed regarding surgical technique, intraperitoneal chemotherapy, and patient outcome.     

Updated treatment of peritoneal carcinomas: a review

Peritoneal surface malignancy (PSM) is a clinical entity with an unfavourable prognosis, which characterizes the evolution of neoplastic diseases from the abdominal and/or pelvic organs and could also be the terminal stage of extra-abdominal tumors. Examples of diseases that can spread mainly within the peritoneal cavity are appendiceal tumors, ovarian cancer, colorectal cancer, abdominal sarcomatosis, gastric cancer and peritoneal mesothelioma. The locoregional therapy is defined as the combination of cytoreductive surgery (CRS) and intraperitoneal hyperthermic perfusion (IPHP). The rationale of this combined therapy for PSM is based on the natural history of this clinical entity that remains confined in the peritoneal cavity for most of its natural history. This pattern of spread would seem to indicate the potential usefulness of selectively increasing drug concentration in the tumour-bearing area by direct intraperitoneal chemotherapy instillation. This approach led to these outcomes: the median survival of colorectal carcinoma and ovarian cancer was 32 months; patients with peritoneal mesothelioma showed 57% survival at 5 years, while in patients with appendiceal mucinous tumors and pseudomyxoma peritonei (PMP) the 10 years overall survival was 78%. A significant improvement in survival was associated with hyperthermic intra-peritoneal chemotherapy (HIPEC) in patients with gastric cancer. Considering the constant increasing of diseases treatable with this procedure, more centres should be activated. The establishment of a clear policy and scientific guidelines is mandatory, in order to perform the CRS+HIPEC safely, minimizing treatment-related morbidity and mortality and maximizing the results in terms of survival and quality of life.     

腹腔镜辅助腹腔热灌注化疗治疗结直肠癌引起的恶性腹水临床疗效及安全性

目的探讨腹腔镜辅助腹腔热灌注化疗(HIPEC)治疗结直肠癌引起恶性腹水的临床疗效及安全性。 方法回顾性分析2014年1月至2015年5月诊断结直肠癌并合并恶性腹水患者35例,分为原发组19例和术后复发组16例,均进行腹腔镜辅助置管腹腔热灌注化疗。采用SPSS 20.0统计分析软件进行分析,HIPEC治疗有效率和术后并发症采用卡方检验;KPS评分采用均数±标准差表示,独立t检验,P<0.05为差异有统计学意义。 结果HIPEC治疗后总有效率为100%,其中完全缓解率85.7%(30/35);两组患者灌注后4周KPS评分较灌注前上升0～20分,原发组上升更明显(P＝0.000);术后复发组不良反应发生率显著高于原发组(P<0.05)。 结论腹腔镜辅助置管HIPEC能缓解结直肠癌引起的恶性腹水,提高患者的生活质量,具有良好的安全性。     

腹腔镜与开腹二期肝切除治疗结直肠癌肝转移的短期疗效比较

【摘要】 目的 探讨腹腔镜肝切除与开腹肝切除对结直肠癌肝转移的短期疗效。方法 自2008年1月至2012年12月,对94例结直肠癌肝转移患者行二期肝切除,其中腹腔镜手术46例,开腹手术48例,收集并比较两组患者的短期疗效资料。所有患者中,左半肝切除35例,右半肝切除28例,不规则楔形切除术31例;原发结直肠癌切除后3~6个月再次采取手术进行肝内病灶切除。 结果 腹腔镜肝切除的结直肠癌肝转移患者术中出血量较开腹组明显减少(P<0.05),住院时间显著缩短(P<0.05),且具有较低的术后谷丙转氨酶、谷草转氨酶、胆红素及白细胞水平(P<0.05)。两组并发症发生率差异无统计学意义。 结论 对于结直肠癌肝转移二期肝切除患者,腹腔镜手术安全可靠,术后短期疗效较开腹好。