目的:探讨血清学检测指标在鉴别原发性与转移性肝癌时的临床应用价值。方法:分别测定125例原发性肝癌患者组,135例转移性肝癌患者组及135例无肝转移的癌症患者组血清中ALT、AST、ALP、TBIL、DBIL、GGT、CHE、5'-NT、AFP、CEA、CA19...目的:探讨血清学检测指标在鉴别原发性与转移性肝癌时的临床应用价值。方法:分别测定125例原发性肝癌患者组,135例转移性肝癌患者组及135例无肝转移的癌症患者组血清中ALT、AST、ALP、TBIL、DBIL、GGT、CHE、5'-NT、AFP、CEA、CA199的水平,采用方差析和Scheffe检验进行统计学分析。应用ROC曲线分析AFP、CEA和CA199对原发性肝癌及转移性肝癌的诊断价值。结果:1)原发性肝癌组与转移性肝癌组之间血清AST、ALP、GGT、5'-NT、AFP及CEA水平差异有统计学意义(P<0.05)。2)根据原发性肝癌组和转移性肝癌组AFP、CEA和CA199的ROC曲线下面积(Area under the ROC curve,AUC)判断,AFP对原发性肝癌诊断有一定的准确性,CEA、CA199对鉴别原发性肝癌与转移性肝癌有一定诊断价值。结论:检测血清AST、GGT、5'-NT、AFP、CEA、CA199水平可对恶性肿瘤是否发生肝转移进行初步诊断,亦可对原发性肝癌与转移性肝癌的鉴别诊断提供佐证。展开更多
BACKGROUND The survival of patients treated with monotherapy for hepatic malignancies is not ideal.A comprehensive program of cryoablation combined with radiotherapy for the treatment of hepatic malignancies results i...BACKGROUND The survival of patients treated with monotherapy for hepatic malignancies is not ideal.A comprehensive program of cryoablation combined with radiotherapy for the treatment of hepatic malignancies results in less trauma to the patients.It may provide an option for the treatment of patients with advanced hepatic malignancies.CASE SUMMARY We reported 5 cases of advanced-stage hepatic malignancies treated in our hospital from 2017-2018,including 3 cases of primary hepatocellular carcinoma and 2 cases of metastatic hepatic carcinoma.They first received cryoablation therapy on their liver lesions.The procedure consisted of 2 freeze-thaw cycles,and for each session,the duration of freezing was 13-15 min,and the natural rewarming period was 2-8 min.Depending on the tumor size,the appropriate cryoprobes were selected to achieve complete tumor ablation to the greatest extent possible.After cryoablation surgery,intensity-modulated radiotherapy(IMRT)for liver lesions was performed,and the radiotherapy regimen was 5400 cGy/18f and 300 cGy/f.None of the 5 patients had adverse events above grade II,and their quality of life was significantly improved.Among them,4 patients were free of disease progression in the liver lesions under local control,and their survival was prolonged;3 patients are still alive.CONCLUSION Our clinical practice demonstrated that cryoablation combined with IMRT could be implemented safely.The definitive efficacy for hepatic malignancies needs to be confirmed in larger-size sample prospective studies.展开更多
We report a case of a 59-year-old gentleman who had suffered from low back pain for several months.Abdominal sonogram showed multiple heteroechoic nodules in the bilateral liver and an enlarged pancreatic head.Abdomin...We report a case of a 59-year-old gentleman who had suffered from low back pain for several months.Abdominal sonogram showed multiple heteroechoic nodules in the bilateral liver and an enlarged pancreatic head.Abdominal computer tomography(CT)favored pancreas head tumor with liver and bone metastasis.Endoscopic retrograde cholangiopancreatography(ERCP)disclosed pancreatic duct invasion over the distal portion of the pancreatic duct with prestenotic dilatation.Liver biopsy showed undifferentiated carcinoma.As suggested by the pathologist,the nasopharyngeal area was checked by the ear,nose and throat doctor,was negative and nasopharyngeal carcinoma was ex-cluded.Therefore,the patient was treated with Gemcitabine(1500 mg/wk),as the suggested treatment schedule,for 24 wk in opioid dependency program.Sequential abdominal CT during follow up showed the disappearance of liver metastasis and shrinkage of the pancreatic tumor.Repeated ERCP after treatment showed re-channelization of the pancreatic duct.During11 years of follow up,5 CT scans disclosed not only the disappearance of the hepatic tumor but also no cancer recurrence.Progressive shrinkage of pancreatic head was also noted.Therefore,we can say this malignant case was cured by monotherapy with gemcitabine.展开更多
文摘目的:探讨血清学检测指标在鉴别原发性与转移性肝癌时的临床应用价值。方法:分别测定125例原发性肝癌患者组,135例转移性肝癌患者组及135例无肝转移的癌症患者组血清中ALT、AST、ALP、TBIL、DBIL、GGT、CHE、5'-NT、AFP、CEA、CA199的水平,采用方差析和Scheffe检验进行统计学分析。应用ROC曲线分析AFP、CEA和CA199对原发性肝癌及转移性肝癌的诊断价值。结果:1)原发性肝癌组与转移性肝癌组之间血清AST、ALP、GGT、5'-NT、AFP及CEA水平差异有统计学意义(P<0.05)。2)根据原发性肝癌组和转移性肝癌组AFP、CEA和CA199的ROC曲线下面积(Area under the ROC curve,AUC)判断,AFP对原发性肝癌诊断有一定的准确性,CEA、CA199对鉴别原发性肝癌与转移性肝癌有一定诊断价值。结论:检测血清AST、GGT、5'-NT、AFP、CEA、CA199水平可对恶性肿瘤是否发生肝转移进行初步诊断,亦可对原发性肝癌与转移性肝癌的鉴别诊断提供佐证。
基金Supported by Health Commission of Hebei Province,No.G2018068
文摘BACKGROUND The survival of patients treated with monotherapy for hepatic malignancies is not ideal.A comprehensive program of cryoablation combined with radiotherapy for the treatment of hepatic malignancies results in less trauma to the patients.It may provide an option for the treatment of patients with advanced hepatic malignancies.CASE SUMMARY We reported 5 cases of advanced-stage hepatic malignancies treated in our hospital from 2017-2018,including 3 cases of primary hepatocellular carcinoma and 2 cases of metastatic hepatic carcinoma.They first received cryoablation therapy on their liver lesions.The procedure consisted of 2 freeze-thaw cycles,and for each session,the duration of freezing was 13-15 min,and the natural rewarming period was 2-8 min.Depending on the tumor size,the appropriate cryoprobes were selected to achieve complete tumor ablation to the greatest extent possible.After cryoablation surgery,intensity-modulated radiotherapy(IMRT)for liver lesions was performed,and the radiotherapy regimen was 5400 cGy/18f and 300 cGy/f.None of the 5 patients had adverse events above grade II,and their quality of life was significantly improved.Among them,4 patients were free of disease progression in the liver lesions under local control,and their survival was prolonged;3 patients are still alive.CONCLUSION Our clinical practice demonstrated that cryoablation combined with IMRT could be implemented safely.The definitive efficacy for hepatic malignancies needs to be confirmed in larger-size sample prospective studies.
文摘We report a case of a 59-year-old gentleman who had suffered from low back pain for several months.Abdominal sonogram showed multiple heteroechoic nodules in the bilateral liver and an enlarged pancreatic head.Abdominal computer tomography(CT)favored pancreas head tumor with liver and bone metastasis.Endoscopic retrograde cholangiopancreatography(ERCP)disclosed pancreatic duct invasion over the distal portion of the pancreatic duct with prestenotic dilatation.Liver biopsy showed undifferentiated carcinoma.As suggested by the pathologist,the nasopharyngeal area was checked by the ear,nose and throat doctor,was negative and nasopharyngeal carcinoma was ex-cluded.Therefore,the patient was treated with Gemcitabine(1500 mg/wk),as the suggested treatment schedule,for 24 wk in opioid dependency program.Sequential abdominal CT during follow up showed the disappearance of liver metastasis and shrinkage of the pancreatic tumor.Repeated ERCP after treatment showed re-channelization of the pancreatic duct.During11 years of follow up,5 CT scans disclosed not only the disappearance of the hepatic tumor but also no cancer recurrence.Progressive shrinkage of pancreatic head was also noted.Therefore,we can say this malignant case was cured by monotherapy with gemcitabine.
