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primary hepatic carcinoma

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primary hepatic carcinoma primary carcinoma of the liver ... – PowerPoint PPT presentation

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Title: primary hepatic carcinoma


1
?????
  • primary hepatic carcinoma

2
? ?
  • ?????(primary carcinoma of the liver)?????????????
    ?????,????????????

3
? ?
  • ?????,????????????
  • ???????,?4049???
  • ? ?2.5 1(?????)/ 8 1(??)
  • ?????6?????
  • ???????(2050??)???,?25?????????,?????????????
  • ??????????,??????????
  • HBV???????????HCV????????????
  • 75??????

4
???
  • ???,??????????2,?????4/100,000(?500010000?)
  • ???????????gt100/100,000
  • ?????,????????????130?

5
?????????
6
????????????????????
7
???????
  • ?????
  • ???
  • ??????????
  • ??

8
???????
  • ?????
  • ???????????????
  • ??HBV????4?,??HBV?????????????????1000?
  • ???1.2?HBsAg???,?90???????????????
  • ??HCV???1.7?,?????HCV????1020,??????????????

9
HBV??????
??
  • ???????????
  • HBV-DNA???DNA??
  • ?????????????????????
  • ??DNA??

10
????????????HBV?HCV???
11
HCV???????
??HBV??
??HCV??
??????
???
????
????
HCV?????????? HBV? HCV??? RNA??,??????
DNA????,??????,?? RNA????????????????? DNA,????
HCV???????? HCV??????????????????????????
12
?????
  • ?70???????????????
  • ???????????????????
  • ????????????36????
  • ??????????????????????HBV?HCV????
  • ?????????????????????????????

13
???????????????
14
?????????
  • ?????B1(AFB1)
  • ?????????????
  • ???????
  • ????????????????????????????????
  • ????????

15
  • ???,??50??????????????????
  • ????,??50?????????????

16
??? ?
  • ??????????????a1-??????????????????? ??? ??
  • ????????????????,???????????????

17
? ?
  • ??????

1979???????????
???
???
???
???
?????3cm????????????????3cm??????
18
  • ??????-?????
  • ?????,????,???,?????,???

19
??? ???
  • ??2.5cm??????,?????????,????

20
? ?
  • ?????

????
?????
???
90
10
21
?????
  • ???????,???????????????????????Caroli?????????????
    ???
  • ???-?????????????????????
  • ???-????????????

22
? ?
  • ????

????
????
????
???????????? ?,????????
?????????????????????
23
????
??????
??
  • ????????
  • ???????????????????????????????????
  • ???????????

24
????
???????
??
  • ??
  • ??
  • ??????????

25
????
??????????
??
  • ?????
  • ??
  • ??
  • ????
  • ???

?????
26
?????
  • ??????????????????????????????????????????????????
    ?????,???????????????????????????????????????,????
    ?????????????

27
????
???????
??
  • ????????
  • ??????,????
  • ??????????????????
  • ??????????

28
????
?????
??
  • ???????????
  • ?????
  • ????,????
  • ????????????
  • ??????????????

29
????
??? ?
??
  • ??????
  • ???????????????
  • ???????????????
  • ????????????????????????????????????,????????

30
????
??
???????
  • ???(?????????????????????????)
  • ?? (???????????)
  • ????????

SAAGgt11g/L
31
  • 1?67?????,??????????,???????????

32
??????
  • ?????????
  • ???

????????
  • ???

???????ALT?gt1?
  • ???

33
??????
  • ?????????????

????????????
?????????????? ??????
34
????(TNM)
??
T1??2cm,????? T2??2cm,????/??????1???,
2cm,?????/??gt2cm,????? T3??gt2cm,????/??????1???,
???? T4??????1???
  • Stage I T1 N0 M0
  • Stage II T2 N0 M0
  • Stage IIIA T3 N0 M0
  • Stage IIIB T1-3 N1 M0
  • Stage IVA T4 N0 M0
  • Stage IVB Tx Nx M1

N0?????? N1???????
M0????? M1????
35
???
????
????????,?1/3????
  • ?????????????????????????????????????????15?
    ???

?????
?????
????
?????????????
36
?????
  • (?)????(AFP)
  • ?????????????,????7090,??????????????????????
  • ??????AFP???????????
  • AFP???????????
  • ????????????AFP?????gt25

37
???AFP??
38
?????
????????
  • (?)?-??????????(?-GT?)
  • (?)??????(AP)
  • (?)a-L-?????(a-AFU)
  • (?)???????(AIF)????A(ALD-A)?5'????????????(5'NPDV)
    ??????????(ALP-?)

?-GT?? AP? a-AFU????AFP??,??????,?????23????
39
?????
  • (?)??????AFP????????
  • (?)?????X?????(CT)??????????????
  • (?)?????(MRI)???????????,???????????CT
  • (?)????????????
  • (?)?????????????(PET)

40
????
  • ????????CT???????
  • ????
  • ????

????2cm????????AFP?????
41
CT ? ?
  • ??CT????????23????CT??,?????0.5cm?????
  • CT????(CTA)?????????,???????????
  • ???CT????(CTAP)??????????????????CT??,?????0.3cm?
    ?????
  • ????CT???????1cm?????????

42
??????????
43
  • ?????510cm?????
  • ?????????????????
  • ?????,?????????

44
??????????
45
  • ??(??CT??)???????
  • ??(2????CT??)??????????????????

46
????????MRI??
47
1????????????????????????MRI??
  • MRI???????????CT

48
  • ?????????,??????
  • ?????????????????

49
?????????
  • ?AFPgt400µg/L,????????????????????????,????????????
    ????????????????????
  • ?AFP400µg/L,?????????????????????????????(AFP????
    AP??-GT2?a-AFU?)???????????????????????
  • ?????????????????????(????????????????????)???????
    ???

50
???????
51
??????
52
????
  • ??????
  • ?????
  • ??????
  • ???

53
????-?????
  • ????????????20???,???1.2?,???????????
  • 90???????
  • ??????,????
  • ??????,HBsAg?AFP????
  • ????????????????

54
????-?????????
  • ??AFP?ALT????
  • ??AFP???????????
  • ?????B??CT?MRI

55
????-???
  • ??????????????????????????????????
  • B???????,????????
  • ??CT?MRI?????
  • ????????
  • ????????????,?????????,????????

56
????-??AFP???????
  • ???????????????,HBsAg??,??????????
  • ????????AFP??????1,B??CT?????????????

57
gt1cm???????
????????????
58
? ?
  • ?????????
  • ????,?????????????
  • ???????,PT????50??,??????????????
  • ?????????

59
? ?
  • ??????????
  • -196? ??????????????????????????????????????????
    ???????
  • ??????
  • (?)????????????(TAE)
  • (?)?????????????????? (PEI)

60
??
??
????????????????
61
?????????????? ?????/??????????TAE???3??
62
  • ???????????
  • ??????
  • ????????????????????
  • ???????60Co???X????????
  • ????????????(IFN?????IL-2?TNF)?????????(LAK?TIL
    AKM)
  • ??????
  • ??????????????????????????????,????????

63
? ?
  • ??????????????
  • ??????5?????3050,????????5?????5060
  • ???????????????????????

????
  • ???????5????28.4
  • 5cm????5????75
  • 3cm????5????83.3

64
??????
  • ??????5cm,??????
  • ????????????
  • ?????????
  • ALT????
  • ?????????????????

???
???
65
? ?
  • ?????????????
  • ?????????
  • ??????,????
  • ????,????

??
66
???
  • ?????????????????
  • ?????????????????
  • ??????????????????????

67
  • That's All.
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