目的：对中药配合肝动脉栓塞化疗（Transcatheter Arterial Chemoembolization,TACE）辅助治疗原发性肝癌随机对照试验(Randomized controlled trial,RCT)文献进行评价。方法：对国内外公开发表的有关中药配合TACE辅助治疗原发性肝癌的随机对照试验进行检索，检索数据库包括Cochrane图书馆临床对照试验库，MEDLINE、CBM、CNKI和VIP电子数据库。手工检索中文相关期刊以及附加检索相关会议论文集。质量评价采用Jadad评分量表、CONSORT标准和其他自拟评价指标进行分析。结果：共纳入103篇RCTs，其中Jadad评分得5分有1篇文献，3分1篇，2分10篇，71篇1分，其余20篇均为0分，有3篇文献报告了分配隐藏。按CONSORT标准，仅1篇(0.97%)RCT描述了如何产生随机顺序，没有RCT报道如何执行随机，其中1篇为半随机，有1篇(0.97%)RCT采用安慰剂对照，有54篇(52.43%)报道了终点指标，分别各有2篇(1.94%)报道了双盲和单盲，14篇(1359%)进行了具体统计量计算，54篇(52.43%)提供了随访记录，7篇(6.80%)报道了阴性结果，16篇(15.53%)报道不良事件，仅有1篇(0.97%)进行样本含量计算与意向性分析(ITT),有2篇(1.94%)进行分层分析，属于多中心的仅有1篇(0.97%)，均未进行伦理审批和知情同意。描述了中医证型的有3篇(2.91%)。结论:目前中药配合TACE辅助治疗原发性肝癌临床研究的方法学和报告质量尚低，且多数RCT可能存在选择性偏倚和测量性偏倚，期待更多高质量的随机双盲对照试验为临床应用提供可靠的依据。
目的探讨肝血管瘤切除术中血流阻断方法的选择。方法回顾性分析我院收治的19例肝血管瘤患者的手术方式。结果全组均行手术切除，术中出血50～1 500 ml（平均312 ml）。 术中根据血管瘤所在位置选择不同肝血流阻断方法，其中行半肝血流阻断4例，运用Glisson蒂横断式肝切除术或其分段原理阻断Glisson系统分支6例，间断阻断第一肝门7例，预置肝上、下下腔静脉和第一肝门阻断带并间断阻断第一肝门2例。 术后5例并发右侧胸腔积液，均经保守治疗后好转，手术并发症发生率为26.3%（5/19）。 术后住院7～41 d（平均16.9 d），均治愈出院。12例患者获随访，随访0.3～2年（平均1.1年），术前有症状的8例患者症状均消失，无复发，1例残留肝内血管瘤（直径lt;2 cm）。结论肝血管瘤患者肝切除术中的入肝血流阻断应强调个体化，根据肿瘤位置及大小选择不同的阻断方法，使患者术中出血少，术后恢复快。
Objective To establish the model of hepatic VX2 tumor in rabbits and to offer the experimental evidences for the application of the model. Methods The hepatoma model was reproduced with VX2 cell lines in rabbits. The method to reproduce the model was improved. The changes of liver function (ALT, AST and TB) were determined at a different phase. Tumor’s growth and metastases, pathological changes, images and spontaneous survival time of the animal were observed. Results The tumors could grow up to 1.5-2.0 cm in diameter in 3 weeks after implanting. The successful rate of implantation was 100%. Nodular enhanced echo was found in the liver by color ultrasound. CT scans showed the low density foci in liver, while enhanced CT scans demonstrated asymmetrical intensification in the foci. Macroscopic observation showed that the tumors were grayish white in color and felt harder, necrotic foci was present in the center of tumor. Observation with light microscope showed that the tumor cells’ nucleoplasm proportion was great, tumor cells arranged irregularly, and the tumors displayed invasive growth and no obvious envelope around them. Animals’ spontaneous survival time was 40-53 days. The cause for their death was multiple system organ failure. Conclusion In pathological morphology, pathological process and prognosis, the hepaticVX2 tumors in rabbits are similar to human hepatocarcinoma. It has such characteristics as easy reproduction, short growth period, high success rate, high stability and so on. The model is an ideal hepatoma model in animals.
Objective To evaluate the role of contrastenhanced CT (CECT) scanning in the diagnosis and treatment planning of some rare liver tumors. MethodsWe retrospectively reviewed the CECT imaging features of 10 cases with rare tumors of the liver proved by surgical pathology in 8 cases or by liver biopsy in 2 cases, with correlation of relevant clinical manifestations, laboratory results and surgical findings. ResultsThree cases were histopathologically proved to be benign, and 7 cases were malignant. On CT images, the liver lesions were mixed cysticsolid in 5 cases, totally solid in the other 5. Eight cases demonstrated heterogeneous enhancement, while 2 cases of liver lymphoma had no enhancement. The anatomic relationship of tumors to intrahepatic vasculature, the compression and infiltration of neighboring abdominal structures were accurately delineated by CT as compared with findings at operation. Clinical manifestations and laboratory findings were not useful for the qualitative diagnosis of rare liver tumors, except for hepatocellular carcinoma. ConclusionCECT is very useful for the detection of rare liver tumors and the fine depiction of local extent of these tumors. When correlated with clinical and laboratory information, it helps to differentiate rare liver tumors from hepatocellular carcinoma. But its role in the characterization of rare liver tumors is limited.
Objective To investigate the inhibitory effect of proliferation cell nuclear antigen (PCNA) antisense oligonucleotides mediated by liposome transfection on hepatocellular carcinoma cell proliferation. MethodsThe antisense oligonucleotides were complementary to 18mer sequences next to the start codon of PCNA mRNA sequences. The human hepatocellular carcinoma cell line Bel7404 was treated with antisense oligonucleotides. The inhibition of proliferation was estimated by MTT method. We compared the deference between the liposome mediated transfection technique and direct transfection technique. ResultsThe cell proliferation was inhibited effectively by antisense oligonucleotides. A sense sequence oligomer showed no effect.Liposome mediated transfection could enhance the inhibitory effect. Conclusion Liposome mediated transfection could enhance the inhibitory effect of PCNA antisense oligonucleotides on hepatocellular carcinoma cell proliferation.
目的探讨透明细胞型肝癌的诊断与治疗。方法回顾性分析了1988年4月至2001年2月我院外科收治的3例患者的临床资料。结果3例均为女性，HBsAg阳性2例。B超检查3例，CT和MRI扫描各2例，影像学诊断各不相同。均经手术行肿瘤切除治疗。手术后随访生存5年以上2例。结论早期积极采取手术切除治疗，是取得较好临床疗效的关键。
Objective To study the results of in situ microwave thermocoagulation therapy for liver neoplasms. Methods Thirty-one patients (male 28, female 3) with liver neoplasms underwent in situ microwave thermocoagulation therapy in recent 4 years were studied. The time of the therapy arranged from 2 to 6 minutes with the core temperature from 110℃ to 125℃. Twenty six of the thirty one (83.9%) were followed up. Results Ninty point three percent of these patients have a good result. The average survival time after the operation was 19.7 months. One-year and three-year survival rate were 77.4% and 38.7%, respectively. Conclusion The in situ microwave thermocoagulation therapy have the advantages of causing slight trauma, promoting repair, good tolerance and curative effectiveness. It’s a simple, safe and effective method with less adverse effect for treating the liver neoplasms, especially for unresectable neoplasms.
To investigate the mRNA expression of nm23-H1 gene in human liver tumor. In tumor and corresponding nontumoral liver specimens from 20 patients, nm23-H1 mRNA were examined by reverse transcriptionpolymerase chain reaction (RT-PCR) method with specific primers. Results: The primers designed in this study could amplified nearly entire coding sequence of nm23-H1 gene. All the samples showed positive expression of nm23-H1 mRNA, indicating there was no expression loss or obvious alteration. Conclusions: The achievement of RT-PCR method lays foundation for quantitative gaugement of nm23-H1 mRNA in liver tumor.
This paper reports twelve patients underwent repeat hepatic resection because of the recurrence of hepatocellular carcinomas after primary resection. The indication of reoperation, selection of incision, difficults encountered in the operation and the treatment after operation are discussed. The authors believe that the second operation is technically more difficult than the first one, some troubles my be happened during the operation and put forward some ways to deal with this situations.
【摘要】 目的 探讨磁共振动态增强扫描及磁共振弥散加权成像（diffusion weighted imaging，DWI）对肝癌经导管动脉内化学栓塞（transcatheter arterial chemoembolization，TACE）治疗后的肿瘤残余及复发的判断价值。 方法 2009年1月-2010年10月，对28例经证实的肝癌患者在TACE治疗前、治疗后3~7 d及治疗后1~2个月、3~6个月行磁共振动态增强及DWI扫描，动态测量表观弥散系数（apparent diffusion coefficient，ADC）值，与数字减影血管造影（digital substraction angiography，DSA）检查对照，评价动态增强扫描及DWI对肿瘤残留或复发的检出能力。〖HTH〗结果 对肿瘤残余及复发的显示，动态增强扫描灵敏度为90.0%，特异度为96.9%；DWI灵敏度为96.7%，特异度为93.8%；动态增强扫描与DWI相结合的灵感度为100.0%，特异度为99.5%；DSA灵敏度和特异度分别为96.7%、100.0%。TACE治疗前所有肿瘤实质的ADC值为（1.134±0.014）×10-3 mm2/s；TACE治疗后3~7 d ADC值为（1.162±0.016）×10-3 mm2/s；TACE治疗后1~2个月碘油沉积较好，无明显残余或复发病灶的ADC值为（1.175±0.015）×10-3 mm2/s，3~6个月后随访病灶ADC值为（1.179±0.017）×10-3 mm2/s；TACE治疗后1~2个月碘油沉积不完全或无明显沉积病灶ADC值为（1.147±0.016）×10-3 mm2/s，3~6个月后随访病灶实质平均ADC值（1.142±0.012）×10-3 mm2/s。 结论 将动脉增强扫描与DWI相结合可提高对TACE治疗后肝癌残余及复发判断的灵敏度及特异度；对肿瘤组织平均 ADC值的动态测量、观察可及早判断肿瘤复发的可能性。【Abstract】 Objective To evaluate the dynamic contrast-enhanced MRI and diffusion weighted imaging (DWI) in judging the remnant and recurrence on hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods Between January 2009 and October 2010, 28 patients with HCC underwent dynamic contrast-enhanced MRI and DWI before and after TACE 3-7 days, 1-2 months and 3-6 months, respectively, and the apparent diffusion coefficient (ADC) value of the tumor were also measured at above mentioned time points. The sensitivity and specificity of dynamic contrast-enhanced MRI and DWI in diagnosis of residual tumor and recurrent cancer was qualitatively evaluated by comparing with the DSA results. Results Compared with DSA, the sensitivity and specificity of dynamic contrast-enhanced MRI were 90.0% and 96.9% by revealing the remnant and recurrence of HCC, while the sensitivity and specificity of DWI were 96.7% and 93.8% respectively. Combining dynamic contrast-enhanced MRI and DWI the sensitivity and specificity were improved to 100.0% and 99.5%, respectively. The mean ADC value of tumor before and after 3-7 days of TACE were (1.134±0.014)×10-3 and (1.162±0.016)×10-3 mm2/s, respectively. The mean ADC value of tumor without and with remnant and recurrence after 1-2 months and 3-6 months follow up were (1.175±0.015)×10-3, and (1.179±0.017)×10-3 mm2/s; (1.147±0.016)×10-3 and (1.142±0.012)×10-3 mm2/s, respectively. Conclusions Combining dynamic contrast-enhanced MRI and DWI could improve the sensitivity and specificity to detect the remnant and recurrence of HCC after TACE. Measuring the ADC value during follow up of HCC patients after TACE could predict the probability of tumor recurrence.