63例原发性肝癌临床分析

The dincal analysis of 63 patients of PrimaryHepar Carcinoma

目的探讨PHC的临床特点,以利早期诊断、治疗,延长患者的生存期。方法对63例PHC患者进行分析,观察其年龄、性别、病史、家族史、临床症状及体征、并发症及预后、病原学、肝癌标记物及影像学检查。结果PHC患者与乙型肝炎及肝硬化密切相关,PHC以肝硬化为主要群体,乙肝肝硬化是PHC最重要的高危因素。男性明显多于女性,男女之比3.2∶1。PHC患者发病年龄主要集中在41～65岁之间。女性患者发病年龄较男性明显高PHC的发生与母婴传播密切相关,与癌症的家族遗传性可能有一定关系。PHC患者的主要临床表现:乏力、腹胀、黄疸、腹水等与基础肝病症状体征难以区分。血性腹水提示对PHC的诊断有一定意义。癌结节破裂出血为PHC晚期的常见并发症。癌结节破裂出血及消化道出血是PHC最多见的并发症,PHC最常见的死亡原因是消化道出血,其次是肝昏迷及肝肾综合征。PHC的预后差,住院死亡率及未愈退院率为15.9%及14.3%,提示医学干预的重要性。结论本研究显示63例PHC中前C区变异的慢性HBV感染者发生肝癌机率高。具有病毒复制易导致PHC。彩超结果提示肝右叶更易发生PHC(57.4%)。肝左叶伴左门脉栓子形成机率高(55.6%),可能肝左叶PHC更易发生转移。

Objective We study the dincal Charactors of PHC in order to early diagnose. Cure end perlong the patients life span. Methods There are 63 patients. We observe their age. Sex history of PHC family history clinical symptom and sign complications prognosis etiolopy. Marker of PHC and reports of imageology. Resuits ther is close relation between PHC and CHB and LC. PHC mainly come from LC. And the most important high riskfactor of PHC is LC caused by CHB. The number of female patients is obviously more than the male＇s, And the ratio is 3.2：1. The age of onset of PHE is mainly between 41 and 65. And female obviouly older than male. The PHC related closely with vertical fransmission and probably relected with familical inherifance. It is difficult to distinguish the main clinical manifestations from basic hepar pathy by debilitation, abdominal distention jaundice ascites, Bloody ascites help to diagnose PHC. Hemorrhage of carcinoma nodus and alimentary tract are the most complications in which hemorrhage of carcinoma nodus of occred in the late period, And hemorrhage of alimentary tract is the most cause of death, And the second cause are hepatic coma and nepaforenal syndrome. The prognosis of PHC is poor, And the death rate and discharge rate which the patients aren＇t/t cured are 15.9% and 14.3%. which infrared the importance of medical intervention. Conclusions The study show that there are higher opportunity to cause PHC in the patients whose HBV varied inpro-c region. Further more, those whose HBV replicated are easier to cause PHC. By bus, there are 57.4% of PHC in the right lobe, and 55.6% in the lefe lobe accompanied with embolus in the left portal vein, which may infer that PHC in left lobe is easier to extension.