177例40岁以下原发性肝癌合并乙肝肝硬化患者临床分析

Clinical Analysis of One Hundred and Seventy-Seven Patients Below 40 Years Old with Primary Hepatic Cancer Associated with Liver Cirrhosis Due to Hepatitis B

作者: 专业:消化内科 导师:唐国都 年度:2011 学位:硕士  院校: 广西医科大学

Keywords

40years old, hepatitis B, liver cirrhosis, primary liver cancer

        目的总结分析40岁以下原发性肝癌(PHC)合并乙肝肝硬化患者临床特点,并探讨诊治策略。方法对广西医科大学第一附属医院2001年1月至2010年8月177例40岁以下PHC合并乙肝肝硬化住院患者临床资料进行回顾性分析。结果本组资料共收集病例177例,占同时期PHC合并乙肝肝硬化住院患者14.1%。本组资料显示本院近10年来40岁以下PHC合并乙肝肝硬化患者以男性为主,占92.7 %,男女比例为12.62:1。患病人群中位年龄为35岁,高峰年龄为30~39岁,占84.2%。既往有明确乙肝病史92人,占52.0%,患乙肝年限从1年~24年不等,平均9.9年。有肝癌家族史20人,占11.3%。临床表现多样,以右上腹疼痛、肝脏肿大、乏力消瘦、腹水为主,分别占59.3%、33.3%、29.4%、19.2%。血清乙型肝炎病毒标志物检测显示以HBsAg、抗HBe、抗HBc阳性为主,占60.9%。AFP阳性率84.5%。所行CT或MRI患者提示肝癌形态以块状型为主,占48.5%,小肝癌18例,占13.4%。影像学结果提示合并门静脉癌栓32例,占25.0%。本组接受手术治疗68人,肝移植2人,可手术率39.5%。手术病理结果提示以肝细胞癌为主,占95.6%:肿瘤细胞分级以Edmondson-SteinerⅡ级为主,占51.1%。结论40岁以下PHC合并乙肝肝硬化患者以男性为主,常见临床表现为肝区疼痛、乏力消瘦、肝肿大、腹水等,影像学以块状型多见,门脉癌栓合并率高,而且可手术率低。需重视对血清AFP水平弱阳性及阴性患者PHC的排除。
    Objective:To summarize the clinical characteristics of patients below 40 years old with primary hepatic cancer (PHC)associated with liver cirrhosis due to hepatitis B, and to explore the strategies of diagnosis and treatment retrospectively .Methods: The clinical data of 177 cases were reviewed which were below 40years old and had PHC associated with liver cirrhosis due to hepatitis B from January 2001 to October 2010 in the first affiliated hospital of Guangxi Medical University.Results: One hundred and seventy-seven patients were included in this paper, account for 14.1% of total amount inpatients with PHC at the same time. The data indicated that male patients were account for 92.7 %, the proportion of male and female was 12.62︰1.The median age was 35yeas old, and 30~39 years old was the age vulnerable(84.2 %). There were 92 patients with a definite history of hepatitis B(52.0%). The illness courses were from 1 to 24years, average 9.9 years. There were 20 patients with a PHC family history(11.3%). There were variable kinds of clinical manifestations in these patients, mainly right upper abdominal pain (59.3%), hepatomegaly(33.3%), hypodynamia and symptosis(29.4%), ascites(19.2%). Detection of serum hepatitis B virus markers indicated that the positive rate of HBsAg、anti-HBe、anti-HBc was 60.9%. The positive rate of serum AFP was 84.5%. Results of CT and MRI indicated that massive type was the mainly morphology of PHC(48.5%). There were 18 cases of small liver cancer(13.4%). There were 32 cases PHC with portal vein tumor thrombosis(25%). The number of patients who received surgery resection and liver transplantation were 68 and 2 cases, respectively, operability rate was 39.5%. The pathology after surgery was predominantly hepatocellular carcinoma(HCC, 95.6%), and Edmondson-Steiner gradeⅡwas common in tumor differentiation diagnosis.Conclusions: Most patients with PHC below 40 years old associated with liver cirrhosis due to hepatitis B are male, right upper abdominal pain、hepatomegaly, hypodynamia and symptosis, ascites are the most common manifestations, massive type is the mainly morphology type of PHC and portal vein tumor thrombosis is common, operability rate is low. The patients with low level or negative serum AFP should be paid more attention for PHC diagnosis.
        

177例40岁以下原发性肝癌合并乙肝肝硬化患者临床分析

一、论文:177 例40 岁以下原发性肝癌合并乙肝肝硬化患者临床分析4-35
    1. 中英文缩略词对照4-5
    2. 中文摘要5-7
    3. 英文摘要7-8
    4. 前言9-10
    5. 材料与方法10-11
    6. 结果11-23
    7. 讨论23-29
    8. 结论29-30
    9. 参考文献30-35
二、综述:小肝癌诊断研究进展35-44
    1. 综述正文35-41
    2. 参考文献41-44
三、致谢44
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