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重视肝癌介入治疗的研究
肝癌介入疗法已有20多年历史,主要分为放射介入和B超介入或经血管间接途径和经皮直接途径.较常用的有:①经动脉插管化疗(TAC)、栓塞(TAE)和化疗栓塞(TACE).
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老年肝癌的诊治进展
恶性肿瘤好发于中老年人.随着社会安定、经济生活改善及医药卫生事业的进步,我国人口老龄化的趋势已经日益明显.人口构成的老龄化必然导致癌症发病率的增高.老年人常有多数器官功能减退,故老年人的癌症在诊断治疗方面与年轻人亦常有所不同.原发性肝癌(以下简称肝癌)是我国常见恶性肿瘤之一,在沿海的一些地区、其死亡率仅次肺癌居第二位.在各种恶性肿瘤中,肝癌的发病年龄偏轻.1973年我们曾统计全国3 282例肝癌.其中位年龄为43.5岁.近年各地临床医师发现老年肝癌病例增多,我院收治的一组3 578例中≥60岁者603例,占16.85%.这是由于人群的免疫力增强而推迟了发病所致.
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肝积方治疗中晚期肝细胞癌患者的生存分析
原发性肝癌(Primary Liver Cancer)是危害我国人民健康的主要恶性肿瘤之一.自1994年以来,肝癌已经成为我国部分农村首位癌症,在部分城市仅次于肺癌[1].手术治疗对早期肝癌效果较好,但对于中晚期肝癌尤其已经发生转移的肝癌疗效不佳,而中医中药对缓解癌症患者病情、延长生存时间有积极的作用;因此,作者对肝积方治疗及手术治疗的中晚期肝细胞癌患者进行了随访研究,现报道如下.
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细胞因子与放射性肝损伤
一、放射性肝损伤―肝癌放疗关注的问题原发性肝癌( primary liver cancer,PLC)是我国常见的恶性肿瘤之一,每年新发病例超过137 000例,约占世界总发病例数的40%.手术是治疗PLC的首选,但是能手术切除的病例仅占20%~30%,非手术治疗在缓解肝癌症状和延长生存期方面发挥着重要作用[1].放疗作为非手术治疗肝癌的一种重要方式,过去因全肝耐受剂量的影响曾受到限制.
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早期进食促进肝癌患者术后康复的临床护理研究
目的:探讨早期进食对促进肝癌患者术后快速康复的影响。方法随机将60例肝癌肝切除术后患者分成两组:早期进食组30例(A组),常规进食组30例(B组),比较两组患者术后肝功能、胃肠道功能恢复情况、感染率、并发症发生率、营养费用、睡眠质量及住院时间。结果早期进食组患者肠鸣音恢复时间(25.51±4.64)h、肛门排气时间(36.22±5.71)h以及首次排便时间(51.32±7.93)h与常规进食组(41.63±6.16)h,(58.44±7.94)h,(72.83±9.91)h相比有统计学差异(P<0.05);术后第1天肝功能指标差异无显著意义(P>0.05);术后第5天早期进食组谷丙转氨酶(63.22±18.76)U/L、总胆红素(20.12±5.76)μmol/L和直接胆红素(12.46±5.28)μmol/L水平较低,白蛋白(36.43±4.55)g/L水平较高,与对照组[(78.31±20.56)U/L,(25.33±6.26)μmol/L,(16.51±7.35)μmol/L,(31.91±3.66)g/L]相比差异均有统计学意义(P<0.05);两组术后平均睡眠时间(7.9±1.6)h 对(6.0±1.2)h、胃肠道不适(10%对50%)、感染率(6.67%对26.67%)、术后营养费用(1000±433.5)元对(2200±493.4)元、住院时间(7.21±2.21)d 对(8.98±3.14)d比较差异有统计学意义(P<0.05)。结论肝癌肝切除术后早期饮食营养护理计划是更好的围手术期护理方案,安全可行,值得临床上进一步扩大验证。
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原发性肝癌的早期实验室诊断
原发性肝癌(Primary Liver Cancer)是临床上常见的恶性肿瘤之一,全球发病率逐年增长,已超过62.5万/年,位居恶性肿瘤的第5位;死亡接近60万/年,位居肿瘤相关死亡的第3位.在我国,发病人数约占全球的55%,在肿瘤相关死亡中仅次于肺癌[1].由于原发性肝癌早期缺乏典型的临床表现,就诊时多数较晚,难以手术根治,且术后复发率高,疗效差.因此如何获得早期诊断及早期治疗,成为提高原发性肝癌疗效的关键.随着B超、CT等影像学技术的普及和广泛应用,原发性肝癌的诊断和治疗有所提前,同时血清学肿瘤标记物检测也为更早发现肿瘤带来了曙光,现就其肿瘤标记物实验室研究进展作一简述.
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肝癌基因治疗进展
原发性肝癌(Primary liver cancer, PLC)是世界范围内常见的恶性肿瘤之一, 以我国和亚非地区 发病率高.基因治疗是指将人的正常基因或有治疗作用的基因以一定的方式导入人体靶细胞,来纠正基因缺陷或通过药物等手段来逆转某些基因发生改变,从而达到治疗疾病的目的.近年来,随着分子生物学技术的发展,基因治疗成为治疗肝癌的新方法,本文就近年来肝癌基因治疗研究进行综述.
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Cancer as an Environmental Disease:Liver Cancer in Bangladesh
Although cancer is considered a common human genetic disease,there has been no significant evidence showing that it is caused by DNA mutations.DNA mutations as drivers or passengers associated with cancer development have been described in many reports.In addition,it has been shown that environmental factors can induce cancer,and thus,cancer can be considered an environmental disease.Liver cancer has become prevalent in Bangladesh,most l ikely due to environmental pollution as the groundwater is naturally contaminated with toxic levels of arsenic.The harm caused by contamination has not been l imited to l iver cancer,as other cancer types have been reported.Moreover,in worst-case scenarios,intake of arsenic has even caused death.As arsenic is usually found in groundwater worldwide,anyone can be affected.However,intake of only a tiny amount is not considered poisonous.Bangladesh has been greatly suffering from arsenic contamination,and as a result,toxicity and cancer have become prevalent.
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肝癌的血液供应
原发性肝癌(primary liver cancer,PLC,简称肝癌)是我国常见恶性肿瘤之一.由于起病较隐匿,患者就诊时大多已属中、晚期,再加上合并肝硬化及术后复发率高等多种因素,绝大多数肝癌患者需非手术治疗.在目前有肯定疗效的非手术疗法中,首选经导管动脉栓塞化疗(transcatheter arterial embolization,TAE)[1].了解肝癌的血液供应对TAE具有明确的指导意义,尤其是当存在肝癌寄生性供血或肝动脉狭窄闭塞伴肝外侧支血管形成时,熟悉和定位肿瘤的寄生性供血及侧支供血动脉是治疗的基础.近年来,国内外对肝癌的血供均作了一些研究,现综述如下.
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经导管肝动脉栓塞化疗与HBV-DNA关系的研究进展
在乙型肝炎流行的亚太地区,原发性肝癌(primary liver cancer, PLC)是常见的恶性肿瘤,发病率较高,其中70 %~90 %以上与乙肝病毒感染有关[1-2].由于起病隐匿,早期发现比较困难,患者就诊时大多已属中、晚期,失去外科手术切除机会,经导管肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)是目前公认的不能手术切除肝癌的首选疗法[3].
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射频消融在肝癌外科治疗中的应用
原发性肝细胞癌(hepatocellular carcinoma,HCC)是我国常见的恶性肿瘤之一.以肝癌手术切除为代表的外科治疗仍是目前肝癌治疗的首选[1].但由于我国肝癌90%以上有HBV感染背景,多数合并肝硬化[2],患者就诊时晚期癌多、肝功能差,仅有20%~37%能获得手术根治性切除[3],并且术后复发率较高[4].自从上个世纪九十年代初意大利学者Rossi首次利用射频消融(radiofrequency ablation,RFA)技术治疗原发性肝癌以来,短短十几年的时间里,射频消融技术得到了快速发展,临床上也已经被大多数人所接受并广泛应用于肿瘤的治疗中.其原理是通过射频发生器发出的电磁波进人组织,引起局部组织中的离子振荡,相互间摩擦产生热量,使局部组织的温度迅速升高到80~110℃,产生凝固性坏死,从而杀死肿瘤[5].随着射频技术的不断进步,射频消融在肝癌治疗中显示了很好的前景.
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尾状叶巨块型肝癌联合下腔静脉切除1例报道
病例资料患者,男,44岁,因"上腹部胀痛不适1月余"入院.病程中伴纳差、乏力、小便色黄、腹胀;无伴发热,呕血、无便血、黑便、无身目黄染.当地医院CT检查提示:肝尾状叶巨大肿物,侵犯第二肝门.患者有乙肝病史数年,未行正规抗肝炎病毒治疗.入院体检:皮肤巩膜无黄染;剑突下2指可及肿物,质硬,表面光滑,固定,向上边界不清,无明显压痛.肝区叩痛(+)性,余无特殊.
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Liver cancer is a common malignant tumor in China and a major health concern. We aimed to estimate the liver cancer incidence and mortality in China in 2010 using liver cancer data from some Chinese cancer registries and provide reference for liver cancer prevention and treatment. We col ected and evaluated the incidence and mortality data of liver cancer in 2010 from 145 cancer registries, which were included in the 2013 Chinese Cancer Registry Annual Report, calculated crude, standardized, and truncated incidences and mortalities, and estimated new liver cancer cases and deaths from liver cancer throughout China and in different regions in 2010 from Chinese practical population. The estimates of new liver cancer cases and deaths were 358,840 and 312,432, respectively, in China in 2010. The crude incidence, age-standardized rate by Chinese standard population (ASR China), and age-standardized rate by world standard population (ASR world) were 27.29/100,000, 21.35/100,000, and 20.87/100,000, respectively;the crude, ASR China, and ASR world mortalities were 23.76/100,000, 18.43/100,000, and 18.04/100,000, respectively. The incidence and mortality were the highest in western regions, higher in rural areas than in urban areas, and higher in males than in females. The age-specific incidence and mortality of liver cancer showed a rapid increase from age 30 and peaked at age 80-84 or 85+. Our results indicated that the 2010 incidence and mortality of liver cancer in China, especial y in undeveloped rural areas and western regions, were among high levels worldwide. The strategy for liver cancer prevention and treatment should be strengthened.
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肝癌2009年临床研究进展与展望
原发性肝癌(primary hepatocellular carcinoma,PLC)是世界上常见的恶性肿瘤之一,居于恶性肿瘤的第5位,全球发病率已超过100万/年.我国一直是世界范围内的PLC高发区,目前的发病人数约34.7万人,约占全球总发病人数的55%;死亡约32.3万人,约占全球总死亡人数的45%.
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肝癌肝移植的问题与对策
肝移植治疗肝癌已有30余年的历史,其独特地位得到了大多数学者的认可,但对于每一例拟行肝移植治疗的肝癌患者来说,在进行肝移植治疗之前,应对其是否适宜于肝移植治疗、能否接受肝移植治疗及近、远期存活率如何等问题作出审慎地评估和全面地考虑后,再决定是否行肝移植治疗和如何行肝移植治疗.
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氩氦冷冻消融术在肝肿瘤治疗中的临床应用及展望
尽管外科手术是原发性肝癌(primary liver cancer)的首选治疗方法,但确诊时大部分患者已达中晚期,仅约10%~20%的病例能获得手术切除,术后5年生存率在12%~39%左右.研究[1]显示,肿瘤负荷与患者生存期相关,且原发性肝癌对放疗、化疗不甚敏感,因此,对于不能切除或不愿意接受手术切除的肝癌患者积极采用针对局部病灶的微创消融治疗为主的综合治疗,能减少肿瘤产生的局部压迫、阻塞症状,减缓肿瘤迅速增大对肝功能的破坏,减轻症状,延长生存期.
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肝切除术治疗BCLC-B期/C期肝细胞性肝癌患者的生存获益较佳
肝切除术(hepatic resection,HR)在肝细胞性肝癌(hepatocellular carcinoma,HCC)根治性治疗中应用广。在HCC的各种临床分期系统中,应用广泛的是巴塞罗那临床肝癌(barcelona clinic liver cancer,BCLC)分期系统,欧洲肝脏研究协会和美国肝病研究协会指南的制订正是基于这一系统。这些指南推荐,HR仅适用于早期HCC,而对于中晚期HCC患者则更适合于经肝动脉化疗栓塞(transarterial chemoembolization,TACE)治疗。新的一些发表在Lancet、J Hepatol、Semin Liver Dis期刊上的肝脏研讨会和指南,虽然认为肿瘤大小不应该作为HR的选择标准,但这些研讨会和指南并未明确推荐HR一线治疗孤立性大肿瘤、多结节肿瘤或合并血管侵犯的HCC。而且,这些指南甚至认为肝硬化合并门静脉高压的HCC是HR的相对禁忌证。有趣的是,亚太肝病研究协会、日本肝病协会和美国肝胆胰协会则认为在长期生存率方面,HR是部分孤立大肿瘤、多结节和(或)合并血管侵犯的HCC患者的佳治疗措施。
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Bioinformatics analysis of exosome proteome derived from hepatic carcinoma HepG2 cells
Objective:The aim of this study was to analyze the exosome proteome derived from hepatic carcinoma HepG2 cells and normal hepatocytes HL-7702,and look for the key factors in carcinogenesis of hepatocellular carcinoma (HCC).Methods:HepG2 and HL-7702 cells were cultured,and exosome samples were obtained from the culture supernatant and verified.LTQ-Orbitrap Elite mass spectrometry was applied to analyze and identify the exosome proteome derived from the hepatic carcinoma cells and normal liver cells,which was for seeking hepatic carcinoma cells specifically expressed proteins.Furthermore,gene ontology (GO),protein-protein interaction (PPI) network,and pathway enrichment were constructed to analyze hepatic carcinoma cells specifically expressed proteins.Results:The exosomes of HL-7702 expressed 3,366 proteins,and the exosomes of HepG2 expressed 2,874 proteins,of which 1,224 were expressed specifically in HepG2 exosomes.102 target proteins were selected and going on bioinformatics analysis under the condition that the unique peptide was ≥1 and PSMs ≥10.GO analysis results showed that the target expression protein of HepG2 was concentrated on metabolism,proliferation,and localization adhesion function.76 target proteins were chosen and formed a PPI network;combining with pathway analysis,ACTN1,FN1,RAC1 and GSN were found to be involved in important signaling pathways of HCC.The 26 target proteins which not in PPI network were analyzed pathway involved in,respectively.AKR1C2 and C5 were found to be involved in differently important signaling pathways of HCC.Conclusion:Exosomes proteomics provides the sources of specific protein derived from hepatic carcinoma cell;when it combines with bioinformatics analysis,they are able to reveal the important molecules that are related to carcinogenesis of HCC and provide new ideas for investigation of HCC biomarkers.
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如何早期发现肝癌
同病不同命40岁的肝癌患者张先生,这两天脸上笑眯眯的,原因是他接受肝癌切除术后3年多了,这次例行复查,医生再次告诉他肝癌没有复发!而他的父亲,同样也是患上了肝癌,从发现到死亡只有短短3个月!想到给父亲和自己看病的是同一个大夫,张先生私下里禁不住总是感叹,同病不同命,还是自己的命好啊!同样是肝癌,为什么结局差别这么大呢?果真是张先生命好,同病不同命?
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对肝癌射频治疗的几点新认识
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