肝脏疾病本科彭涛2011 课件.pptVIP

转移性肝癌-背景 发生率较HCC高20倍 约50%来自消化系统 分型：同时性转移，异时性转移 常见原发灶: 乳腺、肺、胰腺、胃、大肠、肾、卵巢、子宫… 途径: 体循环、门静脉、淋巴、邻近肿瘤侵犯 Metastatic neoplasms of the liver The numerous mass lesions that are of variable size. Some of the larger ones demonstrate central necrosis. The masses are metastases to the liver. This large solitary metastatic nodule was from a colon primary; the glairy cut surface represents a high mucin content. Metastatic neoplasms of the liver Here are liver metastases from an adenocarcinoma primary in the colon, one of the most common primary sites for metastatic adenocarcinoma to the liver Multiple confluent nodules with central umbilication and peripheral hyperemia are classic for metastasis to liver; the primary here was a breast carcinoma. 转移性肝癌-临床表现 症状 体征: 乏力、消瘦、厌食 上腹疼痛、腹水、黄疸、发热、白细胞升高… PE: 肝脏肿大、肿块、触痛、脾大、腹壁静脉曲张 转移性肝癌-临床表现 实验室检查： Hematocrit 30~36%↓ bilirubin, ALP 肿瘤标志物：CEA,CA125,19-9 活检 转移性肝癌-临床表现 影像学： 超声: 初筛 CE-CT: MRI： This computed tomographic (CT) scan without contrast of the abdomen in transverse view demonstrates multiple mass lesions resulting in a markedly enlarged liver extending from right to nearly the left side of the upper abdomen. These are metastases from a colonic adenocarcinoma. A normal sized spleen is seen at the lower left This computed tomographic (CT) scan with contrast of the abdomen in transverse view demonstrates multiple mass lesions representing metastases from a colonic adenocarcinoma. A normal spleen appears at the lower right in the image (on the patients left). 转移性肝癌-治疗 手术切除的指证 无肝外转移 技术可行 对以下疾病可能达到根治性切除的效果: 结肠、胰岛细胞癌、类癌、邻近肿瘤侵犯. 对以下疾病可能效果有限: 乳腺、胰腺、胃、女性盆腔脏器、肺. 转移性肝癌-化疗 经肝动脉插管化疗：优于全身化疗 肝动脉结扎或栓塞 课外阅读参考文献： 2010年 《结直肠癌肝转移诊断和综合治疗指南》--中华胃肠外科杂志2010，Vol 13(6):457 肝血管瘤 1/100,000 5/100,000 背景 – 流行病学 全球发病率在上升 发病有地理特征 非洲: 164.6/100 000 (莫桑比克) 美国：标化发病率 1--7/100 000 /年 男性多于女性：4—9 :1（1:1 in group without preexistent liver disease） 移民美国的东方人发病率6倍高于白人 20/100,000 40/100,000 NPC HCC 中国是HCC高发地区 Global Cancer Statistics, 2002. CA Canc