目的:通过数字减影血管造影(DSA)研究原发性肝癌(HCC)CT增强门静脉期强化特点及其原因。方法:本组HCC门静脉期强化共4例,行CT双期增强扫描及肝脏供血动脉DSA检查,分析供血动脉特点与门静脉期强化间的关系。结果:本组门静脉期均强化。完全性门静脉期强化1例,其供血动脉来源于膈下动脉及肝动脉分支1例;区域性门静脉期强化3例,其供血动脉来源于膈下动脉2例,来源于胃十二指肠动脉的网膜分支1例。供血动脉均走行较长。结论:HCC门静脉期强化供血动脉走行较长,部分管径纤细,导致肿瘤强化延迟。
【Abstract】ObjectiveTo evaluate the value of MR imaging with a contrast-enhanced multi-phasic isotropic volumetric interpolated breath-hold examination (VIBE) in diagnosis of primary liver carcinoma. MethodsThirty-two consecutive patients with surgical-pathologically confirmed 42 foci of primary carcinoma of liver underwent comprehensive MR examination of the upper abdomen, routine two-dimensional (2D) T1WI and T2WI images were acquired before administration of Gd-DTPA for contrast enhancement. Then, contrast-enhanced multi-phasic VIBE was acquired followed by 2D T1WI images. The lesion appearances on hepatic arterial, portal venous and equilibrium phases of VIBE sequence were carefully observed along with delineation of hepatic arterial and portal venous structures. The lesion detection rates and lesion characterization ability were compared among various MR sequences. Results33(78.6%), 30(71.4%), 38(90.5%) and 42(100%) foci were displayed respectively on T2WI, non-enhanced T1WI, enhanced T1WI and enhanced 3D-VIBE images (P＜0.05). The hepatic arterial anatomy of 30 patients （93.8%） and the portal venous structure of 31 patients （96.9%） were clearly depicted on enhanced 3D-VIBE images. Using MIP and MPR reconstruction techniques, the feeding arteries of 14 foci and draining vein of 12 foci were clearly displayed.ConclusionHigh-quality 3D-VIBE images are not only better than 2D images in lesion detection and characterization for primary liver carcinoma, but also able to provide much more information about hepatic vascular anatomy.
Objective To understand the role and mechanism of tumor associated macrophages (TAM) on the occurrence and development of primary liver cancer, and its application in the treatment. MethodThe related literatures about the researches of relation between TAM and primary liver cancer at home and abroad in recent years were collected, sorted out, and made a review. Results Under different stimulating factors, TAM could be polarized to anti-tumor type 1 TAMs or tumor-promoting type 2 TAMs, and type 2 TAMs was the main part in the tumor microenvironment. Through some mechanisms such as vascularity-promoting, invasion-promoting, and immunosuppression to promote the occurrence and development of tumors, and potential treatment plans for primary liver cancer could be found by targeting TAM from different perspectives. Conclusion TAM has a wide range of effects on primary liver cancer, and their mechanisms are complex, understanding the relation between them and make an effective control of TAM could provide new therapeutic ideas and plans for clinical treatment of primary liver cancer.
Objective To study the efficiency of percutaneous acetic acid injection (PAI) or percutaneous ethanol injection (PEI) in the treatment of primary hepatic carcinoma (PHC). Methods Seventeen and 24 patients with PHC were treated, respectively by PAI or by PEI in our hospital. According to hepatic function test, soluble intereukin-2 receptor (sIL-2R), AFP, biopsy and size of tumor, the evaluation was made.Results Effective rate was 88.2% in PAI group and 87.5% in PEI group, respectively. There was no obvious influence to sIL-2R in serum in the two groups (Ｐ＞0.05). Obvious differences in impairment of hepatic functions between PAI and PEI groups were found (Ｐ＜0.01), it also showed that smaller amounts of acetic acid and less puncture frequency were required for the treatment than that of ethanol. Conclusion PAI is superior to PEI in the treatment of those patients who are complicated with cirrhosis or other vital disease.
ObjectiveTo study the epidemiologic characteristics of primary liver cancer (PLC). MethodsThe literatures about regional distribution and etiologic epidemiology of PLC were reviewed. Results PLC was mainly distributed on caostland in the south-east of China. The main cause of PLC was hepatitis B virus, aflatoxin and contamination of drinking water. Otherwise, PLS was also related with lack of some trace element, sex horemones, genealogy cause and so on.Conclusion The genesis of PLC was by multiple factors.
Objective To summarize the role of the relationship between liver cancer and cellular immunological function, and the role of immune therapy in clinical application. Methods To analyze the relationship between liver cancer and cellular immunological function, and the present research situation of immune therapy for liver cancer in clinical application retrospectively via review the related domestic and foreign literatures. Results The cellular immune dysfunction existed in all liver cancer patients. The state of body’s cellular immunological function is closely related with the arising and development of liver cancer, and the lowness of cellular immunological function is an important factor of hepatocellular carcinoma hard to cure or recurrence and metastasis. Immune therapy plays an important role in the treatment of liver cancer by adjusting the body’s cellular immunological function. Conclusions Liver cancer is closely related with the body’s cellular immunological function. Immune therapy is expected to offer a new way for the treatment of liver cancer, which can also be used as an important auxiliary treatment way.
ObjectiveTo study the clinical role of spleen/remnant liver volume ratio in evaluating liver reserve function after surgical treatment for liver cancer. MethodsTo calculate the ratio of spleen volume/remnant liver volume after tumor excision with imaging method and immersion method; to analyze the relationships between spleen/remnant liver volume ratio and liver function score after operation as well as hospital stay. ResultsLiver function ChildPugh score was related mainly with spleen/remnant liver volume ratio (t=7.831, P=0.000), which was proved by multiple regression analysis. The median hospital stay of the group with spleen/remnant liver ratio ≤0.9 was 14 d （12-16 d）, which was less than that (22 d, 15-29 d) of the other group with the ratio gt;0.9 (P=0.000). ConclusionsSpleen/remnant liver volume ratio can predict effectively recovery ability of patients after operation for liver cancer， and assess correctly the reserve function of liver. When the ratio is less than or equal 0.9, the operation is safe.
目的了解腹腔镜肝切除术（laparoscopic hepatectomy，LH）与开腹肝切除术（open hepatectomy，OH）治疗原发性肝癌的围手术期状况的变化。 方法回顾性分析2012年1月至2013年6月期间青岛大学医学院附属医院肝胆外科收治的40例原发性肝癌患者的临床资料，其中20例行LH，20例行OH，比较2组患者的术前一般情况、术中情况和术后恢复情况。 结果2组患者术前一般情况的差异均无统计学意义（P＞0.05）；在切口长度、术中出血量、术后肝功能指标、胃肠功能恢复情况和术后住院时间方面LH具有明显的优势（P＜0.05），而在手术时间、术后并发症和住院总费用方面2组间差异无统计学意义（P＞0.05）。 结论LH较传统的OH可明显改善肝癌患者的围手术期状况，值得在有条件的情况下开展推广。