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,??????????????
9HBV??????
??
- ???????????
- HBV-DNA???DNA??
- ?????????????????????
- ??DNA??
10????????????HBV?HCV???
11HCV???????
??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?????
41CT ? ?
- ??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??
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?????????????
57gt1cm???????
????????????
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