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Selection for Resection of Hepatocellular Carcinoma and Surgical Strategy

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SelectionforResectionofHepatocellularCarcinomaand

SurgicalStrategy:IndicationsforResection,Evaluationof

LiverFunction,PortalVeinEmbolization,andResection

DarioRibero,MD,1StevenA.Curley,MD,1HiroshiImamura,MD,2

DavidC.Madoff,MD,3DavidM.Nagorney,MD,4KelvinK.Ng,MD,PhD,5

MatteoDonadon,MD,6ValerieVilgrain,MD,7GuidoTorzilli,MD,PhD,6MarkRoh,MD,8

andJean-NicolasVauthey,MD1

1DepartmentofSurgicalOncology,TheUniversityofTexasM.D.AndersonCancerCenter,1515HolcombeBlvd,Houston,Texas77030-4009,USA2Hepato-Biliary-PancreaticSurgeryDivision,ArtificialOrganandTransplantationDivision,DepartmentofSurgery,GraduateSchoolofMedicine,UniversityofTokyo,Tokyo,Japan3DepartmentofInterventionalRadiology,TheUniversityofTexasM.D.AndersonCancerCenter,1515HolcombeBlvd,Houston,Texas77030-4009,USA4DivisionofGastroenterologicandGeneralSurgery,MayoClinic,RochesterMinnesota,USA5DepartmentofSurgery,TheUniversityofHongKong,Medical,CentreQueenMaryHospital,HongKong,China6LiverSurgeryUnit,ThirdDepartmentofSurgery,UniversitySchoolofMedicine,IstitutoClinicoHumanitasIRCCS,Rozzano,Milan,Italy7DepartmentofRadiology,HopitalBeaujon,Clichy,France8DepartmentofSurgery,DrexelUniversityCollegeofMedicine,AlleghenyGeneralHospital,Pittsburgh,Pennsylvania,USA

KeyWords:Hepatocellularcarcinoma–Liverresection—Patientsselection—Portalveinembo-lization—Chemoembolization—Intraoperativeultrasonography—Radiofrequencyablation.

Amongthepotentiallycurativetreatmentoptions

forhepatocellularcarcinoma(HCC),liverresectionis

widelyconsideredthemainstayofcurativetherapy.

Animportantaspectofthemorbidity,mortality,and

long-termoutcomeofliverresectionforHCCrelates

topatientselection.Choiceoftreatmentprimarily

dependsontumorstageandthefunctionalstatusof

theliverbecausemostpatientswithHCCharbor

chronicliverdisease.1Forthisreason,whencom-

paredwithpercutaneousablationtherapiesortran-

sarterialchemoembolization(TACE),surgeryhasa

higherriskasaresultofremovaloffunctioningliver

parenchyma.Carefulassessmentoftheclinicalseverityofcirrhosisandtheliverfunctionalreserveis

thereforepivotaltoensuresuitableselectionof

appropriatecandidatesforresection.

Ourobjectiveistoreviewthecurrentindications

forliverresectioninpatientswithHCC,topresent

thecurrentcriteriaforselectionofsurgicalcandi-

dates,andtodiscusspreoperativeandintraoperative

strategiestoimprovethesafetyofliverresection.

TUMORSTAGE

Theassessmentoftumorextentistheprimarystep

fordeterminingresectabilityandtheappropriatetype

ofsurgicalresection.Triphasiccontrast-enhanced

computedtomography(CT)isessentialtodefinethe

numberandsizeoftheHCCs;todetectthepresence

ofsatellitenodulesandtumorinvasionoftheportal

vein,itsbranches,ortheinferiorvenacava;to

ex-ReceivedJune11,2007;acceptedJuly17,2007;publishedonlineJanuary31,2008.Addresscorrespondenceandreprintrequeststo:Jean-NicolasVauthey,MD;E-mail:jvauthey@mdanderson.org

PublishedbySpringerScience+BusinessMedia,LLCÓ2007TheSocietyofSurgicalOncology,Inc.AnnalsofSurgicalOncology15(4):986–992DOI:10.1245/s10434-007-9731-y

986cludeanyextrahepaticmetastasis;and,forsurgical

planning,toclarifytherelationshipofthetumors

withtheintrahepaticvascularandbiliarystructures.

Magneticresonanceimagingistheimagingmodality

ofchoicewhencontrastagentsarecontraindicatedor

betterlesioncharacterizationisneeded.Theroleof

positronemissiontomographyinthepreoperative

workupisstillnotstandardized,butitcanbeuseful

todetectextrahepaticmetastases.

BecausemostHCCsdevelopinpatientswith

chronicliverdiseaseduetohepatitisvirusinfectionor

alcoholabuse,1theprognosisofHCCpatientsde-

pendsnotonlyontumorstage,butalsoonthe

underlyingliverfunction.Therefore,severalprog-

nosticstagingmodels,2accountingforboththeextent

ofHCCandthefunctionalreserveoftheliver,have

beendevelopedtopredictsurvivalandassessout-

comesoftherapy.Oneofthesesystems,fromthe

BarcelonaClinicLiverCancer(BCLC)group,strat-

ifiespatientsintofourcategories(i.e.,early,inter-

mediate,advanced,andterminal),recommendingfor

eachdiseasestagedifferenttreatmentoptions.3

AccordingtotheBCLCstagingsystem,whichhas

beenrecentlyintegratedintotheAmericanAssocia-

tionfortheStudyoftheLiver(AASLD)guidelines,4

hepaticresectionhasamarginalroleinthetreatment

ofHCCandisindicatedonlyinpatientswithearly-

stageHCCdefinedempiricallyby(1)theMilancri-

teria5(andnotbythetumor,node,metastasissystem

AmericanJointCommitteeonCancer/International

UnionAgainstCancerstagingsystems)6,7;(2)normal

clinicalperformancestatus;and(3)preservedliver

function(bilirubinlevels<1mg/dL,absenceof

portalhypertension,andChild-PughclassAstatus).

Thereisnodoubtthatpatientswithearly,small

HCChaveexcellentprognosisafterhepaticresec-

tion.8However,retrospectiveanalysesoflarge-size

surgicalseriesshowthat43%to48%ofpatients

treatedwithcurativeliverresectionhavedisease

合集下载

肝细胞癌根治性切除术后早期肝内复发的影响因素分析

肝细胞癌根治性切除术后早期肝内复发的影响因素分析

肝细胞癌根治性切除术后早期肝内复发的影响因素分析

郭哲;向邦德;倪航航;高军平

【摘 要】Objective To investigate the risk factors influencing early

intrahepatic recurrence of hepatocellular carcinoma( HCC ) after curative

resection, so as to provide the reference for forecasting the early

intrahepatic recurrence. Methods Seventy patients who underwent curative

resection for HCC were divided into two groups:40 cases in early

recurrence group( < 2 years ) and 30 cases in non-early-recurrence group( >

2 years ), then the clinical data of two groups were analyzed. Results

Univariate analysis showed that the symptoms of abdominal pain,

preoperative serum ALP > 135 U/L,preoperative serum AFP >400

ng/ml,perioperative blood transfusion and tumor diameter ≥5 cm might

correlate with the early intrahepatic recurrence of HCC after curative

resection( P < 0. 05 ). The result of multivaiiate analysis indicated that the

肝动脉栓塞术加射频消融与体外高频热疗治疗原发性肝癌及转移性肝癌疗效与安全性

肝动脉栓塞术加射频消融与体外高频热疗治疗原发性肝癌及转移性肝癌疗效与安全性

肝动脉栓塞术加射频消融与体外高频热疗治疗原发性肝癌及转移性肝癌疗效与安全性

【摘要】 目的：对肝动脉栓塞术加射频消融与体外高频热疗治疗原发性肝癌、转移性肝癌患者的疗效与安全性进行评价。方法：选取笔者所在医院2008年10月-2012年8月收治的100例原发性性肝癌、肝转移癌患者，随机分为试验组（50例）和对照组（50例）两组，对照组患者应用肝动脉栓塞术进行治疗，试验组为在栓塞后一周复查可见有实体肿瘤的患者，对其应用射频消融及体外高频热疗治疗；对患者治疗前后的甲胎蛋白含量进行测定比较，并对治疗后的效果进行评价。结果：试验组甲胎蛋白含量降低情况优于对照组，且治疗总有效率较高。结论：肝动脉栓塞术加射频消融与体外高频热疗治疗原发性肝癌及转移性肝癌的疗效优于单纯肝动脉栓塞术治疗效果，且安全性较高。

【关键词】 肝动脉栓塞术； 射频消融； 体外高频热疗； 原发性肝癌； 转移性肝癌

中图分类号 r575 文献标识码 b 文章编号 1674-6805（2013）2-0025-02

原发性肝癌是临床上一种常见的恶性肿瘤，其发病相对隐匿，因此患者平均生存时间为1～1.5年[1]。当发现明显不适进行就诊时，病情大多已经处于中晚期，手术治疗的效果较差。本次试验旨在探究肝动脉栓塞术加射频消融与体外高频热疗治疗原发性肝癌

及转移性肝癌的疗效，具体试验报告如下。

1 资料与方法

1.1 一般资料

本次试验选择笔者所在医院2008年10月-2012年8月收治的100例原发性肝癌、转移性肝癌患者，其中男64例，女36例；所有患者的年龄37～75岁，平均51.8岁；病程为3～7个月，平均4.7个月。在进行治疗前，所有的患者均进行原发性肝癌、转移性肝癌的诊断并最终确诊。将患者分为试验组（50例）和对照组（50例）两组，两组患者在性别、年龄等方面的比较差异无统计学意义。

乙肝相关性肝癌和丙肝相关性肝癌的临床病理特征及意义

乙肝相关性肝癌和丙肝相关性肝癌的临床病理特征及意义

乙肝相关性肝癌和丙肝相关性肝癌的临床病理特征及意义

舒苗江;阚和平

【摘 要】目的：探讨乙肝相关性肝癌和丙肝相关性肝癌在临床病理特征的差异，以及这些差异的临床意义和对预后的影响。方法收集2003年12月～2010年10月在南方医科大学附属南方医院行手术治疗C－HCC标本18例和2011年3月～2012年12月行手术治疗的B－HCC标本34例，以及这些肝癌患者的临床病理资料。分析乙肝相关性肝癌和丙肝相关性肝癌在临床病理特征的差异，以及这些差异的临床意义和对预后的影响。结果乙肝相关性肝癌平均年龄（46．9±10．5）显著低于丙肝相关性肝癌组（59．0±9．9），平均住院天数（17．9±6．8）显著低于丙肝相关性肝癌组（34．9±16．5），平均术后住院天数（11．5±4．3）显著低于丙肝相关性肝癌组（19．4±11．9），肝功能分级中A级肝功明显较丙肝相关性肝癌组多，最大肿瘤直径明显大于丙肝相关性肝癌组，差异均有统计学意义（P＜0．05）。 B－HCC组患者中位无瘤生存时间为13个月，1年、2年无瘤生存率分别为56．3％和32．0％；C－HCC组患者中位无瘤生存时间为16．5个月，1年、2年无瘤生存率分别为75％和75％。Cox模型分析提示肝炎类型是肝细胞癌术后复发的独立影响因素。乙肝相关肝细胞癌术后复发的风险是丙肝相关性肝癌的2．35倍（P＝0．108）。结论乙肝病毒与丙肝病毒相关肝细胞癌的临床病理特征及预后有显著差异。乙肝相关性肝癌术后恢复较丙肝相关性肝癌快，而丙肝相关肝细胞癌术后复发风险低于乙肝相关肝细胞癌。%Objective To

investigate the role of hepatitis B virus (HBV) and hepatitis C virus (HCV) in

clinicopathological features and pro gnosis of patients with hepatocellular

注射用阿奇霉素对小儿支原体肺炎治疗的效果和安全性分析

注射用阿奇霉素对小儿支原体肺炎治疗的效果和安全性分析

第50

卷第11

期

2020

年11

月新禮医学

XI^IANG MEDICAL JOURNALV

〇1.50 No. 11

November.2020

•短篇论著•

注射用阿奇霉素对小儿支原体肺炎治疗的效果和安全性分析

聂晓娟

(乌鲁木齐市友谊医院，乌鲁木齐830000)

摘要：目的研究小儿支原体肺炎注射用阿奇霉素治疗的效果和安全性。方法回顾性选取2019

年1

月至2019

年

12

月本院小儿支原体肺炎患儿128

例，依据治疗方法分为注射用阿奇霉素治疗组（阿奇霉素组,n = 68

)和注射用吉他霉素治

疗组（吉他霉素组,n = 60)

两组，统计分析两组患儿的临床疗效、症状体征消失时间、X

线检查正常时间、不良反应发生情况。

结果在治疗的总有效率方面，阿奇霉素组为92.6%(62/68),

吉他霉素组为78.3%(47/60),

前者显著高于后者(

户<0.05

)。阿奇

霉素组患儿的高热、痰多、咳嗷消失时间均显著短于吉他霉素组(P<0.05),X

线检查正常时间显著短于吉他霉素组(P<0.05

)。

在不良反应发生率方面，阿奇霉素组为7.4%(5/68),

吉他霉素组为15.0%(9/60),

前者显著低于后者(/><0.05

)。结论小儿支

原体肺炎注射用阿奇霉素治疗的效果和安全性较注射用吉他霉素治疗好，值得在临床推广应用。

关键词：注射用阿奇霉素；小儿支原体肺炎;

治疗效果;安全性

中图分类号:R567.2

文献标识码:A

文章编号：1001—5183(2020)11—1183—03

Efficacy and safety of azithromycin for injection in the treatment of mycoplasma pneumonia in children

NIE Xiaojuan

(Uruinqi Friendship Hospital, Urumqi, 830000, China)

Abstract: Objective To study the efficacy and safety of azithromycin in the treatment of mycoplasma pneumonia in children.