摘要
目的探讨肝细胞癌(肝癌)合并胰腺癌的诊治特点。方法回顾性分析2017年7月中山大学附属第三医院收治的1例肝癌合并胰腺癌患者临床资料。患者签署知情同意书,符合医学伦理学规定。患者男,43岁。肝功能Child-Pugh分级A级。因“肝癌消融术后3年,检查发现胰体肿物4d”入院。既往有慢性HBV感染史20余年。3年前因肝癌行超声引导下肝癌微波消融术。MRI复查示肝癌消融术后改变,胰腺良性肿瘤。超声造影示肝内消融灶内无明显血流灌注,胰腺癌并脾动脉受侵犯。入院诊断为肝癌合并胰腺癌。经过积极术前准备,于2017年7月12日行胰体尾联合脾切除术。结果术后病理结果示胰腺中低分化腺癌,伴神经侵犯,肠系膜上动脉旁淋巴结和脾动脉旁淋巴结转移,脉管内癌栓;临床分期为T2N1M0,ⅡB期。术后予6个周期的GX辅助化疗方案,化疗期间无明显并发症,目前患者无瘤生存超过24个月。结论肝癌合并胰腺癌的发生可能与慢性肝炎有关。临床诊断主要靠高质量的影像学检查、细胞学或组织病理学确诊。根治性切除手术及个体化的化疗方案是实现长期无瘤生存的重要决策。
Objective To investigate the diagnosis and treatments of hepatocellular carcinoma(HCC)complicated with pancreatic cancer.Methods Clinical data of 1 patient with HCC complicated with pancreatic cancer admitted to the Third Affiliated Hospital of Sun Yat-sen University in July 2017 were retrospectively analyzed.The informed consent of the patient was obtained and the local ethical committee approval was received.The male patient was 43 years old.The liver function was classified as Child-Pugh grade A.He was admitted to hospital due to"pancreatic mass found for 4 d after radiofrequency ablation of HCC for 3 years".He had a medical history of chronic HBV infection for over 20 years.The patient received ultrasound-guided microwave ablation of HCC 3 years ago.MRI reexamination detected a lesion following HCC ablation and a benign pancreatic tumor.Contrast-enhanced ultrasound revealed no obvious blood perfusion in the intrahepatic ablation lesion and pancreatic cancer with splenic artery invasion.Diagnosis of HCC complicated with pancreatic cancer were made upon admission.After active preoperative preparation,pancreaticosplenectomy was performed in the patient on July 12,2017.Results Postoperative pathological test reported moderately-poorly differentiated adenocarcinoma of pancreas complicated with nerve invasion,lymph node metastasis of superior mesenteric artery and splenic artery,and intravascular tumor thrombus.The tumor was assessed as stageⅡB(T2N1M0).Postoperatively,6 periods of GX adjuvant chemotherapy were given in the patient.No evident complications occurred during chemotherapy.The tumor-free survival was over 24 months by now.Conclusions HCC complicated with pancreatic cancer is probably correlated with chronic hepatitis.Clinical diagnosis can be confirmed mainly by high-quality imaging findings,cytological or histopathological examinations.Radical resection and individualized chemotherapy play a vital role for the long-term tumor-free survival.
作者
庄宝鼎
卢逸
凌云彪
成娜
邓美海
许瑞云
徐见亮
Zhuang Baoding;Lu Yi;Ling Yunbiao;Cheng Na;Deng Meihai;Xu Ruiyun;Xu Jianliang(Department of Hepatobiliary Surgery,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Pathology,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2019年第6期552-556,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
广东省医学科研基金（A2017042）
关键词
癌
肝细胞
胰腺肿瘤
诊断
治疗
Carcinoma,hepatocellular
Pancreatic neoplasms
Diagnosis
Treatment
